(Left to Right): Dr Jorge Sampaio, UN Secretary-General Special Envoy to Stop TB; Lucica Ditiu, Executive Secretary, The Stop TB Partnership; Michel Sidibé, UNAIDS Executive Director; Osas Ighodaro, Miss Black USA; Ray Chambers, UN Secretary-General Special Envoy for Malaria. UN Headquarters, NYC, on June 6, 2011. Credit: UNAIDS/B.Hamilton

A new epidemiological model produced by the Stop TB Partnership, World Health Organization (WHO) and UNAIDS shows that it is possible to sharply reduce AIDS deaths worldwide by preventing and treating tuberculosis (TB). At present one in four people living with HIV die of TB; the vast majority of these deaths could be averted, since TB is curable.

“Halving TB deaths in people living with HIV by 2015 is possible and is within our reach. We could save up to a million lives by 2015 and bring us one step closer to the UNAIDS vision of zero AIDS-related deaths,” said UNAIDS Executive Director Michel Sidibé.

Building on well-established methods for preventing and treating HIV-associated TB that are recommended by WHO and UNAIDS, the model shows that by scaling up these approaches worldwide a million lives could be saved by the end of 2015.

“There has been a surge in awareness about the deadly TB epidemic among people living with HIV, but insufficient action. Now new scientific work has shown that we can prevent a million deaths among people living with HIV by end 2015 by providing integrated HIV and TB care,” said Dr Jorge Sampaio, the UN Secretary-General's Special Envoy to Stop TB and former President of Portugal. “I call on the world's leaders to take up this challenge. It is time to take bold action. Not to do so would be an outrage.”

A publication that outlines the new model, Time to act: Save a million lives by 2015 - Prevent and treat tuberculosis among people living with HIV, was launched on 6 June at United Nations Headquarters. It calls for the following actions:

• Testing for HIV and TB should be provided every three years in places where both diseases are prevalent.
• Prompt TB treatment needs to be provided to every person living with HIV with active TB—or else treatment to prevent TB.
• HIV and TB treatment must be accessible and of good quality so that people living with HIV are cured of TB.
• Antiretroviral therapy (ART) should be started early, which will help prevent TB, since people living with HIV are far less likely to become ill with and die of TB if they begin ART before their immune systems begin serious decline.
• People who are HIV-positive and diagnosed with active TB should start ART regardless of the status of their immune systems.

In 2010 the Stop TB Partnership and UNAIDS set the joint goal of reducing by half the number of deaths among people living with HIV, compared to 2004 levels, between 2011 and end 2015. With the new model, they have agreed to aim to avert one million deaths.

Civil society is also calling on their governments to fully adopt this TB/HIV plan. “Our message is clear and simple. If people living with HIV don't get tested and treated for TB, many of us will die from this disease, even though we are receiving life-saving antiretroviral treatment. It's a terrible waste, because TB is curable,” said Lucy Chesire, a leading international advocate on behalf of people affected by HIV-associated TB.

It is estimated that the cost of all the elements needed to prevent one million TB deaths among HIV-positive people worldwide would come to about US$ 790 million per year.

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: Carl Kaufman / Yale

The Global Health Leadership Institute (GHLI) of Yale University held its 2011 GHLI Conference from 5-10 June 2011 under the theme of “moving health systems forward”. The Conference convened senior health practitioners from around the world to facilitate collaborative solutions in strengthening health systems.

Speaking on 5 June, UNAIDS Executive Director Michel Sidibé gave an inaugural address to the conference to commemorate 30 years since the start of the AIDS response and shared UNAIDS’ perspective on future directions.

“We are so pleased to have Michel Sidibe join us to open our conference this year and help further bring attention to the role strategic planning and leadership play in helping solve global health issues,” said Elizabeth Bradley, Ph.D., faculty director, Yale Global Health Leadership Institute.  “The conference is about gathering health officials from around the world to share experiences, develop leadership and identify creative ways to solve problems that affect the everyday lives of people in these countries,” she added.

Mr Sidibé stressed the transformative role that the AIDS response has played in community mobilization and strengthening health systems. “The AIDS response has led to enormous progress towards scaling up access to treatment and reaching out to people at risk of HIV infection, with a strong human rights focus. This has been, and continues to be, a catalyst for change in the health systems of many affected countries.”

This year’s week-long event brought together senior health practitioners from Ghana, Liberia, Rwanda, and South Africa to focus on health system issues including mental health, maternal mortality, human resource management and management capacity building. These countries have achieved improvements in health despite limited resources and have gathered to discuss and apply strategic problem solving to national health priorities.

In his speech, Mr Sidibé also recognized the leadership of these four countries and praised their high level representation at the General Assembly High Level Meeting on AIDS.

Each country delegation, comprised of senior leadership from Ministries of Health, non-governmental organizations and academic institutions, brought a health system challenge to address at the conference with the support of Yale faculty and experts. Delegates participated in interactive lectures, cross-country roundtable discussions, keynotes and facilitated work sessions. Delegates met with prominent leaders in global health and received training in strategic problem-solving and leadership.

Global Health Leadership Institute

The Yale Global Health Leadership Institute (GHLI) develops global health leadership through innovative education and research programmes that strengthen the capacity of countries and communities to ensure health equity and quality of care for all.

As the world marks 30 years of AIDS, UNAIDS estimates 34 million [30.9 million–36.9 million] people are living with HIV and nearly 30 million [25 million–33 million] people have died of AIDS-related causes since the first case of AIDS was reported on 5 June 1981

(From left): Michel Sidibé, UNAIDS Executive Director; Christina Rodriguez, Co-Founder, Smart Youth; Asha-Rose Migiro, Deputy Secretary-General at Press conference on AIDS at 30: Progress of nations, held at UN Headquarters, New York City on June 3, 2011.
Credit: UNAIDS/B. Hamilton

NEW YORK/GENEVA, 3 June 2011—About 6.6 million people were receiving antiretroviral therapy in low- and middle-income countries at the end of 2010, a nearly 22-fold increase since 2001, according to a new report AIDS at 30: Nations at the crossroads, released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

A record 1.4 million people started lifesaving treatment in 2010—more than any year before. According to the report, at least 420 000 children were receiving antiretroviral therapy at the end of 2010, a more than 50% increase since 2008, when 275 000 children were on treatment.

“Access to treatment will transform the AIDS response in the next decade. We must invest in accelerating access and finding new treatment options,” said Michel Sidibé, UNAIDS Executive Director. “Antiretroviral therapy is a bigger game-changer than ever before—it not only stops people from dying, but also prevents transmission of HIV to women, men and children.”

His statement follows the recent HPTN052 trial results which found that if a person living with HIV adheres to an effective antiretroviral regimen, the risk of transmitting the virus to his or her uninfected sexual partner can be reduced by 96%.

“Countries must use the best of what science can offer to stop new HIV infections and AIDS-related deaths,” said UN Deputy Secretary-General Asha-Rose Migiro. “We are at a turning point in the AIDS response. The goal towards achieving universal access to HIV prevention, treatment, care and support must become a reality by 2015.”

HIV prevention efforts showing results

According to the report, the global rate of new HIV infections declined by nearly 25% between 2001 and 2009. In India, the rate of new HIV infections fell by more than 50% and in South Africa by more than 35%; both countries have the largest number of people living with HIV on their continents.

The report found that in the third decade of the epidemic, people were starting to adopt safer sexual behaviors, reflecting the impact of HIV prevention and awareness efforts. However, there are still important gaps. Young men are more likely to be informed about HIV prevention than young women. Recent Demographic Health Surveys found that an estimated 74% of young men know that condoms are effective in preventing HIV infection, compared to just 49% of young women.

In recent years, there has been significant progress in preventing new HIV infections among children as increasing numbers of pregnant women living with HIV have gained access to antiretroviral prophylaxis during pregnancy, delivery and breastfeeding. The number of children newly infected with HIV in 2009 was 26% lower than in 2001.

About 115 low- and middle-income countries are providing optimal treatment regimens for pregnant women living with HIV as recommended by the World Health Organization (WHO). There are 31 countries that still use sub-optimal regimens in many of their HIV prevention programmes. UNAIDS urges all countries using sub-optimal regimens to revise their treatment guidelines and make the transition to optimal WHO recommended regimens.

AIDS is not over—significant challenges remain

According to the latest estimates from UNAIDS, 34 million [30.9 million–36.9 million] people were living with HIV at the end of 2010 and nearly 30 million [25 million–33 million] have died from AIDS-related causes since AIDS was first reported 30 years ago.

Despite expanded access to antiretroviral therapy, a major treatment gap remains. At the end of 2010, 9 million people who were eligible for treatment did not have access. Treatment access for children is lower than for adults—only 28% of eligible children were receiving antiretroviral therapy in 2009, compared to 36% coverage for people of all ages.

While the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7000 per day. The global reduction in the rate of new HIV infections hides regional variations. According to the report, above-average declines in new HIV infections were recorded in sub-Saharan Africa and in South-East Asia, while Latin America and the Caribbean experienced more modest reductions of less than 25%. There has been an increase in the rate of new HIV infections in Eastern Europe and in the Middle East and North Africa.

In virtually all countries, HIV prevalence among populations at increased risk of HIV infection—men who have sex with men, people who inject drugs, sex workers and their clients, and transgender people—is higher than among other populations. Access to HIV prevention and treatment for populations at higher risk of infection is generally lower due to punitive and discriminatory laws, and stigma and discrimination. As of April 2011, 79 countries, territories and areas criminalize consensual same-sex relations; 116 countries, territories and areas criminalize some aspect of sex work; and 32 countries have laws that allow for the death penalty for drug-related offences.

According to the report, gender inequalities remain a major barrier to effective HIV responses. HIV is the leading cause of death among women of reproductive age, and more than a quarter (26%) of all new global HIV infections are among young women aged 15-24.

AIDS resources declining

According to the report, investments in the HIV response in low- and middle-income countries rose nearly 10-fold between 2001 and 2009, from US$ 1.6 billion to US$ 15.9 billion. However, in 2010, international resources for HIV declined. Many low-income countries remain heavily dependant on external financing. In 56 countries, international donors account for at least 70% of HIV resources.

“I am worried that international investments are falling at a time when the AIDS response is delivering results for people,” said Mr Sidibé. “If we do not invest now, we will have to pay several times more in the future.”

A 2011 investment framework proposed by UNAIDS and partners found that an investment of at least US$ 22 billion is needed by the year 2015, US$ 6 billion more than is available today. When these investments are directed towards a set of priority programmes that are based on a country’s epidemic type, the impact is greatest. It is estimated that the return on such an investment would be 12 million new HIV infections averted and 7.4 million AIDS-related deaths averted by the year 2020. The number of new infections would decline from about 2.6 million in 2009 to about 1 million in 2015.

Perspectives on AIDS from leaders around the world

The report features commentaries from 15 leaders in the global AIDS response, including South Africa’s President Jacob Zuma, former United States President Bill Clinton, former President of Brasil Luiz Inácio Lula da Silva, the President of Mali, Amadou Toumani Touré, and Jean Ping, Chairperson of the African Union Commission. The commentaries cover a range of areas, such as AIDS funding, South-South cooperation, youth leadership, the empowerment of women, key affected populations, injecting drug use, human rights, stigma and discrimination and systems integration.

Young people leading the HIV prevention revolution

AIDS at 30: Nations at the crossroads also includes an article on a recent event held on Robben Island, South Africa, where Archbishop Desmond Tutu, Co-chair of the UNAIDS High Level Commission on HIV Prevention, passed the baton of leadership in the AIDS response to a new generation of young leaders.

According to the report, some of the most important HIV prevention successes have been led by young people. Data indicate that young people in many heavily affected countries are increasingly adopting safer sexual behaviours.

Dr Paul De Lay at the MDGs Follow-up Meeting
Credit: UNAIDS

The Government of Japan, along with the United Nations Development Programme (UNDP), the United Nations Children's Fund (UNICEF), the World Bank and the Japan International Cooperation Agency (JICA), convened a follow-up meeting on 2-3 June 2011 in Tokyo to discuss the outcomes of the UN Millennium Development Goals (MDGs) Summit that took place in September 2010.

With less than five years remaining before 2015, the target year for achieving the MDGs, the meeting brought together high level delegations from more than 100 countries and international organizations, and provided a unique opportunity to exchange knowledge, as well as to discuss more effective measures to strengthen coordination among a broad range of stakeholders.

The meeting was opened by H.E. Prime Minister Kan, who expressed deep appreciation for the solidarity shown by the international community in the wake of the unprecedented earthquakes and tsunami on 11 March 2011. Mr Kan also assured the audience that Japan remains committed to the achievement of MDGs.

Mr Takeaki Matsumoto, Japan’s Minister of Foreign Affairs, underlined this commitment saying, “Japan remains fully dedicated to carrying out faithfully the international commitments it has expressed in the past to achieving the MDGs.”

UNAIDS Deputy Executive Director, Programme, Paul De Lay took part in the meeting and also participated in one of the several side events, titled Preparing the health systems for the challenges beyond MDGs.

“UNAIDS has called for taking HIV out of isolation. At the High Level Meeting on AIDS next week, one of the major themes will be “integration”, including exploring synergies between HIV programmes and preventing and caring for non-communicable diseases,” said Dr De Lay.

The event, moderated by Dr Suwit Wibulpolprasert, Senior Advisor on Disease Control, Ministry of Public Health, Thailand, included presentations from Michel D. Kazatchkine, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria; Dr Mickey Chopra, Chief, Health Section, Program Division, UNICEF; and Dr Kenji Shibuya, Professor and Chair, Department of Global Health Policy Graduate School of Medicine, The University of Tokyo.

Coming just days before the UN High Level Meeting on AIDS in New York, the meeting enabled participants to exchange their good practices and also learn from others about projects and programmes focused on hard-to-reach regions and groups. Participants also discussed the “way forward” beyond 2015, using lessons learned in the decade under the current MDGs.

During his visit to Japan Dr De Lay also met with Dr Masato Mugitani, Assistant Minister for Global Health, the Ministry of Health, Labour and Welfare and Mr Masaya Fujiwara, Deputy Director-General for Global Issues of the International Cooperation Bureau, the Ministry of Foreign Affairs to discuss Japan’s active participation in the UN High Level Meeting, especially regarding prevention of mother-to-child transmission of HIV. Dr DeLay also met with civil society representatives who will attend the General Assembly event. 

The Global Business Coalition (GBC) Annual Conference and Awards Dinner took place from 1-2 June in New York. This year’s event marked the 10^thanniversary of the coalition and brought together more than 500 business executives, policy makers, celebrities and thought leaders to discuss on the corporate response to global health challenges and identify new avenues for future business action.

The GBC Annual Conference focuses on the unique role that business plays in addressing health challenges—including HIV, within the workplace and in the world at large. During the conference, the GBC announced an opening of its mandate to address not only infectious pandemic diseases but also the full range of global health challenges upon which the private sector can engage.

One of the panel discussions of the conference focused on the power of men to accelerate progress in eliminating the disparities facing women and girls in the world. Entitled Healthy women, healthy economies: Men who make it their business to improve women's lives. The panel brought together business, political and civil society leaders committed to communicating and demonstrating as men that gender inequity is a source of suffering, not power.

“We must engage with men and boys to promote awareness of the need for a ‘new masculinity’ that see women and girls as equal partners,” said UNAIDS Executive Director Michel Sidibé, a speaker at the event. “We need to share good practices; scale up small-scale projects; promote gender-sensitive education in schools; and push national AIDS programmes to engage with men and boys especially in HIV prevention efforts,” he added.

The panel was moderated by Isobel Coleman from the Council on Foreign Relations’ Women and Foreign Policy Program. Ambassador Eric Goosby, the United States Global AIDS Coordinator also spoke. Speakers from the private sector included Jeff Seabright, Chief Environmental Officer at The Coca-Cola Company; Aigboje Aig-Imoukhuede, Managing Director and CEO of Nigeria's Access Bank; Gary Cohen, Executive Vice President, BD and Rick Echevarria of Intel Corporation.

Artist and AIDS activist Whoopi Goldberg hosted the Awards Dinner on 2 June, where the Global Coalition honoured its two founding supporters George Soros and Ted Turner. The GBC also paid special tribute to U.S. Ambassador Richard Holbrooke who headed the Coalition from 2001 to 2009 and passed away earlier this year.

Addressing the gala, UNAIDS Executive Director Michel Sidibé acknowledged the legacy of Ambassador Holbrooke who he described as a “tireless AIDS advocate”. Mr Sidibé also congratulated the GBC for its enduring commitment to AIDS and the world’s health as well as to saving lives of mothers and babies through and bringing TB into workplace HIV programmes.

A version of this story is also published at www.unicef.org

Charles Aheebwa at home with his two months old sister Kaseo. Mugamba, Uganda.
Credit: UNICEF/Tadej Znidarcic

Global efforts to improve the lives of children affected by HIV are increasing but still fall short of the growing needs of millions. An estimated 16.6 million children have lost one or both parents to AIDS-related illness, the vast majority in sub-Saharan Africa.  

This year’s Global Partners Forum on children affected by AIDS brings together 100 high level representatives from governments, civil society, donors, international organizations and academic institutions in an effort to promote evidence-based approaches to improve the lives of children affected by HIV. Under the heading Taking Evidence to Impact, the event, starting 3 June in New York, is jointly hosted by UNICEF, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and UNAIDS.

Keeping mothers and children safe from HIV

Efforts to prevent new HIV infections among children child are critical and can serve as an entry point for care and support for the whole family, particularly through better integration of couples testing and counselling; HIV treatment, care and support; and linkages with HIV testing and treatment within child health services.

“Every mother, father and child should have access to comprehensive health care which includes HIV prevention and treatment,” said Michel Sidibé, Executive Director of UNAIDS who will participate in the forum. “Parents should be given the chance to protect their children from HIV and access life-saving antiretroviral medicine for their own health.”

Enormous challenges

Many children affected by HIV continue to face enormous challenges, including the burden of care for sick relatives, trauma from the loss of parents, economic distress and high health costs. There can also be a heightened risk of early sexual debut and abuse, which can make children—particularly girls—more susceptible to HIV infection.

“These children have already experienced the tragedy of losing a parent or a loved one to AIDS only to be subjected to stigma, discrimination and exclusion from school and social services,” says Dr Anthony Lake, UNICEF Executive Director, “To help these children reach their full potential, we urgently need to invest in national social protection programmes that fight poverty and stigma, and which address the special needs of HIV-affected families.”

Ambassador Eric Goosby, US Global AIDS Coordinator, agrees that targeted investments are needed to improve the lives of children affected by the epidemic. “The U.S. Government is the largest supporter of programs targeting orphans and vulnerable children, and we remain firm in our commitment. Moving forward, we have a shared responsibility to make smart investments that will ultimately ensure a positive future for children affected by HIV/AIDS.”

The two-day forum will review:

• Lessons learned at country level to support children affected by HIV and their families;
• Mechanisms that protect such children from marginalization and discrimination, and increase their access to key social services;
• The importance of child sensitive social protection and strengthening social welfare systems for increasing access to HIV prevention, treatment and care services;
• Increasing the impact of investments and achieve better results for those in greatest need.

The recommendations from the Global Partners Forum will be reflected in discussions during the UN High Level Meeting on AIDS in New York from 8-10 June 2011.

Global Partners Forum

The Global Partners Forum was first established in 2003 to give momentum to fulfilling global commitments for children affected by AIDS laid out in the United Nations General Assembly 2001 Declaration of Commitments on HIV/AIDS and the Millennium Development Goals.



Resolution 67/9 on HIV was endorsed at the 67th UN ESCAP Commission held in Bangkok, Thailand from 19-25 May 2011. Credit: UN ESCAP

In the lead-up to the 2011 General Assembly High Level Meeting on AIDS to take place in New York from 8-10 June, the 62 Members and Associate Members of the United Nations (UN) Economic and Social Commission in Asia and the Pacific (ESCAP) have unanimously adopted a new Resolution on HIV. The resolution reconfirms commitment of countries in the region to reach universal access to HIV prevention, treatment, care and support and to address critical barriers hampering responses to AIDS.

Cosponsored by the Governments of Indonesia, Australia, Fiji, Thailand and Myanmar, the 67^th Commission Session, held at the ESCAP headquarters in Bangkok, Thailand, passed the Resolution on Wednesday 25 May 2011.

The HIV Resolution was developed following the Asia Pacific Regional Consultation on Universal Access held at the end of March, at which over 250 representatives from governments, international organizations, donors and civil society from nearly 30 countries agreed upon necessary actions from the region towards the vision of zero new HIV infections, zero discrimination, zero AIDS-related deaths.

“Thirty years since AIDS was first discovered, many countries have made progress in their HIV responses, but the agenda is unfinished. To ‘get to zero’ we need to unite as a region and redouble our efforts, making sure they are focused to reach those who need them most,” said Dr Nafsiah Mboi, Secretary of the Indonesian National AIDS Commission.

Recalling previously adopted Resolutions and commitments on HIV made by the Commission, ESCAP Resolution 67/9 calls upon members and associate members to further intensify actions to reach the unmet goals and targets of the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS.

The Resolution emphasizes members’ agreements to support the achievement of 80% coverage for populations at higher risk including people who use drugs, people who buy and sell sex, men who have sex with men and transgender people, with a view to achieving targets on universal access to HIV services.

“We welcome this strong endorsement by Members of ESCAP. With less than one month to go before the High Level Meeting on AIDS, this Resolution is timely and shows the commitment of the region to respond to HIV and particularly to removing barriers which can hamper progress,” said UNAIDS Regional Director, Steven Kraus.

The new declaration calls on governments in the region to ensure the commitment of a greater proportion of national resources to improve the programmatic effectiveness of the HIV responses. Resolution 67/9 also urges a review of national laws, policies and practices to enable the full achievement of universal access targets with a view to eliminating all forms of discrimination against people affected and infected with HIV. Finally, it underlines that to better address HIV, countries must continue to develop their national strategies to address all forms of gender-based violence, including sexual violence, particularly against women and girls.

UN ESCAP’s Social Development Director, Nanda Krairiksh underlined the significance of the Resolution endorsement for the region: "Governments in the Asia-Pacific region are moving forward to ensure greater effectiveness in national HIV responses. They are calling for greater financial sustainability, resource allocation and scaling-up of the full range of actions to ensure universal access to HIV prevention, treatment, care and support," she said.  

The Permanent Observer of the African Union to the United Nations (UN) in partnership with the United Nations Senior Africans Group and the African Diaspora hosted an event at the UN on 31 May to celebrate African Liberation Day. The Day holds particular significance this year because the UN General Assembly assigned 2011 as the International Year for People of African Descent. The theme for the year’s event was: Forging closer links between Africa and the Diaspora.

“We are looking towards the great future that the continent can deliver for its people and to the world,” said Ambassador Tete Antonio, Permanent Observer of the African Union to the UN ahead of the event. “There is much to be done, and much that we who are the sons and daughters of Africa can do to build the continent and to build our countries and communities that form this great Diaspora.”

“Coming one week before the 2011 High Level Meeting on AIDS, this day offers a major platform to galvanize Africa, the Diaspora and the international community around the twin engine of assessing the work that has been achieved in the past 30 years of the AIDS epidemic and re-committing the international community to global solidarity and partnership building to move the AIDS agenda forward,” said Dr Djibril Diallo, Chairman of the Host Committee for the Africa Day Celebration and Senior Advisor to the Executive Director of UNAIDS.

Speakers at the event also included Ambassador Joy U. Ogwu, Permanent Representative of Nigeria to the UN, Representative of the African Group and Chair for the Month of May; Maria Luiza Ribeiro Viotti, Permanent Representative of Brazil to the United Nations; Bill Perkins, New York State Senator; Professor Iba Der Thiam, Writer/Historian, First Vice President, National Assembly of Senegal; the Rev. Jesse Jackson, Rainbow PUSH Coalition; Dr Julius Garvey, Pan Africanism and the United States of Africa; Vanessa Williams, Executive Director, National Conference of Black Mayors; and Uchenwa Njokwu, Youth Leader and President of NGO Flaunt Africa.

African Liberation Day is commemorated on 25 May every year in many countries in Africa.

 Joint publication by UNICEF, UNAIDS, UNESCO, UNFPA, ILO, WHO and The World Bank presents data on adolescents and HIV for the first time

Credit: UNICEF

Every day, an estimated 2 500 young people are newly infected with HIV, according to a global report on HIV prevention launched today. While HIV prevalence has declined slightly among young people, young women and adolescent girls face a disproportionately high risk of infection due to biological vulnerability, social inequality and exclusion.

For the first time, Opportunity in Crisis: Preventing HIV from early adolescence to young  adulthood, presents data on HIV infections among young people and highlights the risks adolescents face as they transition to adulthood. A joint publication by UNICEF, UNAIDS, UNESCO, UNFPA, ILO, WHO and the World Bank, the report identifies factors that elevate their risk of infection as well as opportunities to strengthen prevention services and challenge harmful social practices.

“For many young people HIV infection is the result of neglect, exclusion, and violations that occur with the knowledge of families, communities, social and political leaders. This report urges leaders at all levels to build a chain of prevention to keep adolescents and young people informed, protected and healthy,” said UNICEF Executive Director Anthony Lake.  “UNICEF is committed to this cause. We must protect the second decade of life, so that the journey from childhood to adulthood is not derailed by HIV – a journey that is especially fraught for girls and young women.”

According to the report, people aged 15-24 accounted for 41% of new infections among adults over the age of 15 in 2009. Worldwide, an estimated 5 million (4.3 million to 5.9 million) young people in that age group were living with HIV in 2009. Among the 10 to 19 year age group, new data shows, an estimated 2 million adolescents (1.8 million to 2.4 million) are living with HIV. Most of them live in sub-Saharan Africa, most are women, and most do not know their status. Globally young women make up more than 60% of all young people living with HIV. In sub-Saharan Africa that rate jumps to 72%.

"Our success with improving access to antiretrovirals means more young people are surviving with HIV, but many are still unaware of their status,” said World Health Organization Director-General, Dr Margaret Chan. “WHO is committed to helping improve adolescents' access to HIV testing and counselling and to making sure that health services address their needs for prevention, treatment, care and support."

Early adolescence is a window of opportunity to intervene, before most youth become sexually active and harmful gender and social norms that elevate the risk of HIV infection are established. Communities, leaders and young people all have a role to play in changing the behaviours that place young people at risk and creating an environment where they may thrive. In southern Africa, for example where HIV infections are high in older age groups, sex with multiple partners and age-disparate relationships are fuelling HIV transmission among young people, particularly young women. But progress can be made. Community-led efforts to change such norms have been effective in communities in Tanzania, where the image of men seeking relations with younger women and girls was effectively turned into an image of ridicule.

"As the report says, too many adolescent girls become pregnant before they are ready, and have children while they are still children themselves," said UNFPA Executive Director, Dr Babatunde Osotimehin. "This puts their own health and their children’s health at risk and limits their opportunities and potential. To achieve the MDGs, it’s absolutely critical to improve access to comprehensive sexuality education and integrated reproductive health services, including family planning and male and female condoms. Evidence shows that sexual and reproductive health information and services do not lead to more frequent sexual relations or high-risk behaviour, but rather to fewer unintended pregnancies, reduced HIV infections and better health."

Certain high-risk behaviours—such as early sexual debut, pregnancy and drug use – are all signs of things going wrong in the environment of the young adolescent, and may be associated with violence, exploitation, abuse and neglect. Yet social protection systems that are HIV-sensitive can contribute to the financial security of vulnerable families, improve access to health and social services and ensure that services are delivered to marginalized youths.

“The world desperately needs new HIV prevention strategies; for every two people who receive life-saving AIDS treatment, another five become newly infected, which is an impossible situation for many poor countries and their communities,” says the World Bank’s Managing Director, Dr Mahmoud Mohieldin. “Existing prevention strategies have had limited success, so we have to look for creative new approaches to reverse the HIV/AIDS epidemic. These must address people’s very basic needs for education, economic security, inclusion, dignity, and human rights. These issues are particularly crucial when we consider the health and well-being of adolescent girls, mothers and children, and socially marginalized groups.”

Family members, teachers, community leaders have a role to play in setting norms for responsible behaviour, and  in advocating for the full range of services needed for young people to stay healthy. Indeed, reducing the level of HIV incidence requires not one single intervention, but a continuum of prevention that provides information, support and services throughout the life cycle. Yet many adolescents lack access to basic HIV and prevention information, commodities and testing services.

“Young people need to have access to comprehensive knowledge and services in order to make safe choices about their health and relationships,” said UNESCO Director-General, Irina Bokova. “We are fully committed to this effort, leading the evidence-based push to scale up sexuality education and supporting the different needs of young people as they transition from early adolescence to adulthood. We must work together to ensure that all young people, especially girls and vulnerable populations, receive the education, support and protection necessary for preventing HIV and promoting their overall well-being,” she added.

Worldwide many young people driven by economic duress, exploitation, social exclusion and lack of family support turn to commercial sex and injecting drug use. They face an extremely high risk of infection as well as general stigma and discrimination for engaging in such behaviours. The very same young people most often lack access to HIV prevention and protection services. For national HIV responses to be effective, governments need to address the underlying problems of poverty, exclusion and gender inequality that threaten the health of future generations. Using equity as a guidepost helps to ensure those hardest to reach are not last in line, and that services are available to them and used by them.

“Nearly one of every two new adult HIV infections occurs among 15 to 24 year olds. The ILO Recommendation on HIV and AIDS and the World of Work calls for a special focus on young people in national policies and programmes on HIV and AIDS and highlights the role of education and training systems and youth employment programmes and services as critical channels for mainstreaming information about HIV,” said Juan Somavia, Director-General of the International Labour Organization (ILO). “Already young people often bear a disproportionate share of the burden of unemployment, underemployment and poverty, a situation aggravated by the global recession. We must enable young people to realize their full potential. Their strength is the strength of communities, societies and economies.”

As the report points out, there are opportunities to use proven prevention strategies in all epidemic contexts. In countries with generalized epidemics there are opportunities to encourage healthy attitudes and behaviours, ensure greater gender equality and allow protection to become the new norm. In sub-Saharan Africa, for example, the same social norms that tolerate domestic violence also prevent women from refusing unwanted sexual advances, negotiating safe sex, or criticizing a male partner’s infidelity—all of which threatens the goal of achieving an AIDS-free generation. And in countries with low-level and concentrated epidemics, where HIV infections among youth are driven by injecting drug use, sex work, or male to male sex, there are opportunities to reshape the legal and social milieu that compounds vulnerability and to empower young people with knowledge, prevention services and health care.

“Young people are not only tomorrow’s leaders, they are the leaders of today,” said Michel Sidibé, Executive Director of UNAIDS. “If young people are empowered to protect themselves against HIV, they can lead us to an HIV free generation.”



Credit: UNAIDS/P.Virot

Men who have sex with men (MSM) and transgendered people are amongst the most stigmatized populations in the Middle East and North Africa (MENA). In spite of social tension and sensitivities, most countries in the region have recognized the importance of programming for, and working with, MSM to strengthen effective national AIDS responses. Nevertheless, existing prevention programmes have remained limited in scope and scale, highlighting limitations in coverage and quality.

In this context, UNAIDS brought together representatives from civil society, governments, national AIDS programmes and regional and international partners to a workshop in Lebanon to discuss ways to scale up interventions that focus on the needs of MSM in the region.

The workshop was organized in collaboration with Helem-Lebanese Protection for LGBT association, the International AIDS Alliance (AA) and the Regional Arab Network Against AIDS (RANAA). It focused on the outcomes of a policy research project entitled “Enabling Access to HIV Services for Men Who Have Sex with Men - Situational analysis and Partnership Development”. The main purpose of the research, conducted in Algeria, Lebanon, Morocco and Tunisia, was to identify ways to enable and facilitate this access to HIV services.

Existing repressive laws and policies deter MSM from seeking HIV prevention, treatment, care and support services.  Currently 18 of the 21 countries that form the MENA region criminalize male to male sex behaviour—and 4 enforce capital punishment.

Participants at the meeting highlighted the importance of creating enabling environments that allow unrestricted dissemination of prevention messages and services, appropriate provision of HIV treatment, care and support services, and the empowerment of MSM and transgender population in planning, implementing and evaluating programme strategies.

Participants also reviewed a handbook developed by UNAIDS, based on field experiences and lessons learnt, to inform effective, expanded and culturally sensitive programmatic interventions among MSM and transgender people.

“Most programmes in MENA are still at a pilot stage. We need to scale up current programs using the extensive experience over the last years. This handbook, adapted to the region’s context, will hopefully inform interventions among MSM and transgender people,” said Ms Nicole Massoud, Regional Monitoring and Evaluation Advisor for the UNAIDS regional support team.

There are no reliable estimates of the number of men who have sex with men in the region. However, there is documented evidence of increased HIV spread and risk among MSM and transgender people, which may result in concentrated HIV epidemics over the next decade.