Credit: WHO/Oliver O'Hanlon

The full adoption of the new draft World Health Organization (WHO) global health strategy for HIV 2011-2015 will be a key focus of discussion at the 64^th World Health Assembly, taking place in Geneva from 16-24 May and attended by Health Ministers and officials from more than 190 countries. Intended as a global call to action, the comprehensive draft strategy maps out the WHO latest guidance and approaches to successfully challenging today’s evolving AIDS epidemic.

The World Health Assembly, the highest decision-making body of the World Health Organization which sets policy and approves the budget, will also debate a multiplicity of other issues. These include: pandemic influenza preparedness, cholera and the mechanism for control and prevention, infant and young child nutrition, youth and health risks, safe management of drinking water, climate change and health prevention and control of non-communicable diseases and malaria. The future of financing for WHO will also be high on the agenda.

Today WHO Director-General Dr Margaret Chan will address the Assembly and on 17 May invited speakers Mrs Sheikh Hasina, Prime Minister of Bangladesh, and Bill Gates, Co-chair of the Bill & Melinda Gates Foundation, will take the floor.  

Four technical meetings, ranging from public health concerns and radiation health to information and accountability for the health of women and children are also scheduled.

In addition to setting policy, the Assembly will give the gathered government representatives, medical professionals and academics the chance to exchange ideas and experiences. Regional meetings for Ministers of Health are set to provide an opportunity to explore specifically relevant issues.

Credit: UNAIDS

In the sidelines of the World Health Assembly, taking place in Geneva from 16-24 May, UNAIDS Executive Director Michel Sidibé and Brazilian Minister of Health Alexander Padilha met to discuss the global AIDS response and promote South-South cooperation.

Mr Sidibe and Mr Padilha talked about the participation and role of Brazil during the upcoming General Assembly High Level Meeting on AIDS that will take place in New York from 8-10 June 2011.

HIV treatment for prevention was highlighted as one of the country’s success stories and an area where Brazil could drive the push for innovation and transfer of technologies between countries. Both leaders also reflected the sports and HIV advocacy opportunities provided by the FIFA World Cup that will be hosted by Brazil in 2014.

Dr Paul DeLay, UNAIDS Deputy Executive Director, Programme
Credit: UNAIDS

The fourth United Nations Conference on the Least Developed Countries (LDC-IV) ran 9-13 May in Istanbul, Turkey. Member states met to discuss objectives and targets for the next decade 2011-2021.

According to Mithat Rende, coordinator for the LDC-IV, "There are 48 least developed countries in the world with a population of 950 million.” These countries account for 12% of the world’s population and an estimated half of people in these countries live in conditions of extreme poverty.

To place gender equality and the empowerment of women at the centre of discussions on human and social development, a high level interactive debate was held on 12 May.

The debate, which brought together leaders in the field of governance, development and United Nations bodies, was co-chaired by Peter Shanel Agovaka, Minister of Foreign Affairs & External Trade, Solomon Islands and Steven Vanackere, Vice-Prime Minister and Minister of Foreign Affairs, Belgium.

UNAIDS Deputy Executive Director, Programme, Paul De Lay described how an effective and sustainable AIDS response has created solidarity and cohesion around common priority issues across the development spectrum. Addressing the underlying social and economic drivers of the epidemic and companion health, development and rights challenges helps catalyze positive social change and accelerate development. He noted, “Successes will depend on the engagement of key populations in every facet of the response.”

“Removing common barriers that unblock progress on AIDS, such as gender inequality, also advance progress on maternal and child health and universal education,” Dr De Lay said. “The AIDS response has built bridges for health, development and human rights,” he added.

Development, gender inequality, and HIV

The 2010 Human Development Report showed that the countries with low human development score highest in a Gender Inequality Index. Women in these countries have lower access to education and economic opportunities, and lack of a political voice.

Women make up around half of all people living with HIV and 76% of women living with HIV live in sub-Saharan Africa. Some 30 years since AIDS was first reported, persistent gender inequality and human rights violations continue to put women and girls at a greater risk of and vulnerability to HIV.

These obstacles are hampering progress and threaten the gains that have been made in preventing new HIV infections and in increasing access to treatment. In addition to their biological susceptibility to HIV, women and girls face many interacting socio-cultural, economic and legal challenges that amplify their vulnerability.

The participants discussed the need to define concrete goals that can be evaluated by better data in order to mainstream gender and social protection in a meaningful way into development programmes. Ensuring that social protection policies are gender responsive and inclusive are seen as critical components of this agenda for future action. There was a call for smart investments in women and girls and the need to invest in young people including in their education and reproductive health.

Ensuring universal access

Earlier in the week Dr De Lay moderated a side event on Ensuring universal access to HIV prevention, treatment, care and support services: country perspectives during which he gave an overview of the history of universal access. Looking ahead to next month’s General Assembly gathering he said, “The 2011 High Level Meeting from 8–10 June will present a unique opportunity to review progress and reinvigorate the AIDS response. The time has come to reaffirm commitments against global targets.”

A keynote speech was delivered on behalf of Bathabile Olive Dlamini, South Africa’s Minister of Social Development, by Zane Dangor, Special Advisor to the Ministry, Department of Social Development. The speech presented the outcomes of the International Advisory Group on Universal Access which convened recently in Johannesburg, and discussed progress in HIV in the broader context of solidarity for human rights. He stressed that the AIDS movement has proved that human rights are not just about values and ideology:  protecting human rights is a requirement for saving lives. Panelists from Tanzania, Nepal and the African Union illustrated this point with powerful experiences working with national AIDS programmes, young people, communities and families in scaling-up to universal access.

Five-year-old Sophia on her Move it! decorated bike during the launch event of the campaign outside the UN in Geneva.
Credit: UNAIDS

HIV activists, bike enthusiasts, and community members gathered in front of the United Nations in Geneva on 13 May, to launch the television and social media campaign Move it! The campaign aims to create a movement of support for a successful outcome at the United Nations General Assembly High Level Meeting on AIDS in New York from 8-10 June 2011.

Amid HIV bike decorations and music, a more serious matter drew people together on the square. While more than six million people are now accessing treatment in low and middle income countries, and people around the world are adopting safer sexual practices, gains are fragile. There are still about nine million people waiting for treatment, and 2.6 million people were newly infected with HIV in 2009.

“The High Level Meeting on AIDS is an opportunity to shift gears in the AIDS response. To raise awareness in the lead up to the High Level Meeting, we are launching the Move it! campaign,” said Mr Tim Martineau, UNAIDS Director, Programme Effectiveness and Country Support Department. “Without public expectations, we cannot be sure of a successful outcome. Social Media offers an excellent channel to rally such support,” he added.

The campaign will run on social networks from the launch event in Geneva, during three weeks in the lead up to the High Level Meeting on AIDS. People around the world can creatively decorate their bikes with AIDS awareness materials and share photos of their creations on the UNAIDS Facebook page. UNAIDS fans on Facebook will be able to vote for the best bike in early June.

Move it! uses the bike as a vehicle to raise awareness about HIV, with the spinning wheel symbolizing the movement and force of the AIDS response. Anyone can participate and take awareness messages to the streets:

“I like the way the red ribbons go round and around on my wheels,” said five-year-old Sophia decorating her bike.  

The campaign will culminate on 5 June in New York City, ahead of the opening of the High Level Meeting. A campaign video has been developed that will be aired across Africa, and will also be available on UNAIDS YouTube channel.

To find out how to get involved visit www.facebook.com/UNAIDS or join the conversation on Twitter

The International Advisory Group (IAG) on universal access met in Johannesburg, South Africa on 26-28 April 2011 to crystallize key findings informed by the outcomes of recent series of country and regional consultations on universal access. The meeting was an opportunity to gain consensus on global priorities and the “way forward” which is captured in the IAG statement, Solidarity for Universal Access. The IAG is co-chaired by Mrs Bathabile Dlamini, Minister of Social Development, Republic of South Africa and Dr Paul De Lay, UNAIDS Deputy Executive Director, Programme.

The statement will be shared directly with Member States to contribute towards negotiations on a draft declaration in lead up to the United Nations High Level Meeting on AIDS that will take place in June.

Between 2010 and 2011, 117 countries took stock of their progress towards universal access to HIV prevention, treatment, care and support services. The national assessments informed multiple regional consultations.

While reviewing the findings from the country and regional consultations, the IAG, a multi-stakeholder advisory group, mandated by the UNAIDS Programme Coordinating Board, found overwhelming and ongoing support for the universal access movement.

During the April meeting in South Africa, the IAG endorsed the recommendations from the regional and country  consultations and concluded that five global challenges are pivotal now to achieve universal access to HIV prevention, treatment, care and support by 2015. These global challenges include the need to protect the human rights of all people; improve access to quality and affordable HIV treatment and scale up HIV prevention programmes; engage inspiring and courageous leaders, especially young people, lead the response; use evidence-informed strategies to make smart investments that will yield maximum results; and, finally, share accountability.

“We need to strengthen the human rights approach in our response to AIDS and establish mechanisms to ensure that both public and private services are free of stigma and discrimination or homophobia,” said Dr Jose Angel Cordova Villalobos, Secretary of Health of Mexico and member of the IAG during his participation in the Latin America consultation in March this year.

The advisory body emphasizes in its statement that global solidarity on the identified key priorities will change the trajectory of the epidemic, save lives and contribute towards achieving the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

WHO and UNAIDS hail results from the HPTN 052 trial that show antiretroviral therapy to be 96% effective in reducing HIV transmission in couples where one partner has HIV

Credit: UNAIDS/P.Virot.

GENEVA, 12 May 2011—Results announced today by the United States National Institutes of Health show 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%.

“This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “Now we need to make sure that couples have the option to choose Treatment for Prevention and have access to it.”

The trial, conducted by the HIV Prevention Trials Network, enrolled more than 1 700 sero-discordant couples (one partner who is HIV-positive and one who is HIV-negative) from Africa, Asia, Latin America and the United States of America.

Only people living with HIV with a CD4 cell count of between 350 and 550, thus not yet eligible for treatment for their own health according to latest WHO guidelines, were enrolled in the study. The reduction of sexual transmission of HIV was so significant that the trial was stopped 3-4 years ahead of schedule. 

"This is a crucial development, because we know that sexual transmission accounts for about 80% of all new infections," said Dr Margaret Chan, WHO Director-General. "The findings from this study will further strengthen and support the new guidance that WHO is releasing in July to help people living with HIV protect their partners."

The availability of Treatment for Prevention will not only empower people to get tested for HIV, but also to disclose their HIV status, discuss HIV prevention options with their partners and access essential HIV services. It will also significantly contribute to reducing the stigma and discrimination surrounding HIV.

“People living with HIV can now, with dignity and confidence, take additional steps to protect their loved ones from HIV,” said Mr Sidibé.

It is currently estimated that only about half of the 33 million people living with HIV know their HIV status. An increase in the uptake of testing for HIV would have a significant impact on the AIDS response, particularly if more people gain access to treatment in light of the new findings.

UNAIDS and WHO recommend that couples make evidence-informed decisions on which combination of HIV prevention options is best for them. UNAIDS urges that Treatment for Prevention be one of the options made available to couples. The new WHO guidelines coming out in July will help countries to make this a reality for people who choose to use this new HIV prevention option. The guidelines will include specific recommendations on increasing access to HIV testing and counseling and the use of antiretroviral therapy among discordant couples.

No single method is fully protective against HIV. Treatment for Prevention needs to be used in combination with other HIV prevention options. These include correct and consistent use of male and female condoms, waiting longer before having sex for the first time, having fewer partners, male circumcision, and avoiding penetrative sex. The significance of the findings put Treatment for Prevention firmly in the HIV prevention package.

To increase access to the Treatment for Prevention option, the Treatment 2.0 initiative must be urgently implemented to innovate, simplify, reduce costs and mobilize communities to scale up HIV testing and counseling and treatment.

UNAIDS will convene a partners meeting to further discuss this new development and its implications for the AIDS response. This builds on a series of expert consultations which have been convened by UNAIDS and WHO on Treatment for Prevention during the last two years.

UNAIDS and WHO will work with countries and partners to make Treatment for Prevention an integral part of the HIV response and to ensure it is made available to people who wish to use it as soon as possible.

A version of this story was first published at www.unicef.org 

Israel Ndeshaanya and Elisabeth Nagula, with their son, Nicolas.
Credit: UNICEF Namibia/2011/Manuel Moreno Gonzalez

Israel Ndeshaanya and Elisabeth Nagula live together with their 8-month old son, Nicolas, in Windhoek’s Katutura township.   

Elisabeth is HIV-positive and Israel is very supportive of her, ensuring that she takes her antiretroviral drugs regularly. "Since the day she came to know about her status, I’ve never said any bad words to her...We are just as we have been.”

When Elisabeth became pregnant with Nicolas, the couple went through Namibia’s prevention of mother-to-child transmission of HIV programme. Nicolas was born free of the virus. The programme was started almost a decade ago and has been rolled out to 238 of 335 health facilities across the country, treating some 59 000 pregnant women every year.

Men’s participation

However, in Namibia, men who get involved like Mr Ndeshaanya are relatively rare. As with many other countries, men’s participation in health programmes tends to be lower than that of women.

Recent research conducted by UNICEF and the Namibian government shows that only about 3% of male partners of women in the national antenatal care programme took a HIV test in 2010, compared to 96% of women.

The research also shows that men have a direct bearing on their partner’s adherence to the prevention of mother-to-child transmission intervention, accessed through the antenatal care programme. In some cases they can actively work against the goals of the intervention by delaying access to care or withholding financial assistance.

By contrast, supportive men clearly have a positive effect. According to Ian MacLeod, UNICEF Representative in Namibia, to dramatically reduce new HIV infections among children, men’s participation is of critical importance, “A comprehensive response is needed, combining training of health workers, specialized infant feeding counsellors, community level support to breastfeeding mothers...and, very importantly, mothers need the support of their husbands or partners."

New target

This fact is something that Namibian First Lady Penehupifo Pohamba aims to promote through her new campaign to reduce HIV prevalence, which is supported by President Hifikepunye Pohamba, UNICEF and other organizations.

Launching the campaign, the President emphasized the vital role men play in caring for the well-being of their partners and children.

“It is not enough for Namibian men to provide the basic necessities such as a house, food, water, electricity for their families. They should also become actively involved in health issues such as the prevention of HIV,” he said.

President Hifikepunye Pohamba has set an ambitious target for Namibia to increase participation by men in voluntary HIV counselling and testing from 3% to 25% by the end of 2011.

In Namibia an estimated 13% of the adult population is living with the virus and nearly 20% of all pregnant women are reported to be HIV-positive.

From left: Jean-Louis lamboray, Director of The Constellation, one of the facilitators of the AIDS Competence project; Sveta Izambaeva, Niayaz Illiasovich Galiullin, Chief Doctor of the Kazan’s AIDS Center; Dr Denis Broun, Director of UNAIDS Regional Support Team for Europe

"You should not expect a solution to come from the outside. You need to look for it in the very communities and their people,” says the director of the international non-governmental organization The Constellation, Jean-Louis Lamboray during a recent presentation of the AIDS Competence project, in Kazan, Russia.

The objective of this initiative is to mobilize local responses to AIDS by promoting awareness within communities of their own strengths and capacities and facilitating the exchange of experiences within the communities. To accomplish this objective, the AIDS Competence project uses an approach called SALT— Stimulate, Acknowledge, Listen and Transfer—where trained facilitators visit communities to help them identify needs, formulate ideas and to form a leadership team from representatives of the community.

“People have enough wisdom and understanding of the risks. Our challenge is to encourage them to respond to the epidemic. Many communities and people are scattered and we have to help them form the right connections and networks,” added Mr Lamboray.

The meetings between communities and facilitators in Kazan show that when, a community openly acknowledges the risk of HIV, it can take action and mobilize support from within.

“I am a mother and grandmother,” said Irina, who took part in the meeting. “I worry about my family and want to know what I can do to protect them from HIV."

"If we want to get rid of stigma, we have to start from small groups, at home, at work,” said Natalia, whose husband Sergei uses drugs and is HIV positive. “Let’s have a discussion about it with the families in our neighborhood.”   

AIDS response in the Russian Federation

Eastern Europe remains the only region in the world where the epidemic is still on the rise. According to the Federal AIDS Centre in Russia, there are about 160 new registered cases of HIV infection daily in the country and more than 590,000 people are living with HIV. HIV transmission in the country is mainly driven by injecting drug use but heterosexual transmission is on the rise.

“The mobilization of the local response is critical for keeping the HIV epidemic under control in Russia as the lack of funding for HIV prevention programmes at the federal level may cause a serious setback in results achieved in the AIDS response,” said Dr Denis Broun, Director, UNAIDS Regional Support Team for Europe and Central Asia.

UNAIDS seeks to encourage community activism in the country and so it concentrates its advocacy work at decentralized levels for example by linking municipal authorities and civil society groups to help them share experiences and consolidate best practices around HIV prevention.

According to UNAIDS, there are 16.6 million children worldwide that have lost one or both parents to AIDS-related illnesses, almost 15 million of them live in the sub-Saharan Africa region.
Credit: WB/ C.Carnemark.

On 5 May, the External cooperation office of the European Commission provided a platform for representatives of self-support organizations for people affected by HIV from the African migrant community in Brussels to present on the situation of children orphaned by AIDS and other vulnerable children.

Organized by community organizations in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the European Commission, the session brought together officials from the European Union (EU) institutions, permanent representations of EU Member States, civil society and other EU stakeholders.

Speaking at the conference hosted by the European Commission, Loraine Mukazi, who was herself orphaned by AIDS, spoke up for the millions without voice, “Being an AIDS orphan is to become an adult very quickly, a parent for your own parents, a head of a family.”  She added, ”Losing a parent is already difficult, losing a parent to AIDS even more so, as you are confronted with the denial, taboo, stigma and countless questions.”

While fewer people are becoming infected with HIV and fewer are dying from AIDS, the epidemic continues to leave behind a growing number of orphans. According to UNAIDS, there are 16.6 million children worldwide that have lost one or both parents to AIDS-related illnesses, almost 15 million of them live in the sub-Saharan Africa region.

In addition to the trauma of losing a parent, orphans are often subject to discrimination and may be less likely to receive healthcare, education and other needed services. In HIV-affected households lacking social protection or community support, food consumption can drop by 40% putting children at risk of hunger, malnutrition and stunted growth. Impoverished, and without support to educate and protect themselves, orphans and vulnerable children face increased risk of HIV infection.

One of UNAIDS goals outlined in its 2011-2015 strategy is to ensure that all households affected by HIV, including orphans and vulnerable children, are addressed in all national social protection strategies and have access to essential care and support.

Social protection programmes can effectively increase the nutritional, health and educational status of children and reduce their risk of abuse and exploitation, with long-term developmental benefits. Experts agree that child-sensitive social protection should focus on aspects of well-being that include providing adequate child and maternal nutrition; access to quality basic services for the poorest and most marginalized; supporting families and caregivers in their childcare role; addressing gender inequality; preventing discrimination and child abuse in and outside the home; reducing child labour; increasing caregivers’ access to employment or income generation; and preparing adolescents for their own livelihoods, taking account of their role as current and future workers and parents.

Henning Mikkelsen, UNAIDS Representative to the European Union, expressed the hope that the upcoming General Assembly High Level Meeting on AIDS will lead to better social protection for families affected by AIDS and break the vicious circle where orphans and other children become highly vulnerable to HIV.

Students working with the Kenya government officials on sexuality education
Credit: UNESCO/Kenyan Centre for the Study of Adolescence

Sexuality education programmes can be highly cost-effective, especially when compulsory, adapted from existing models and integrated into the mainstream school curriculum. This is the major conclusion emerging from a seminal study released by UNESCO during a meeting of the UNAIDS Inter-Agency Task Team on Education in New York on 27 April 2011.

The study, Cost and cost-effectiveness: Analysis of school-based sexuality education programmes in six countries, examines a range of programmes in Estonia, India, Indonesia, Kenya, the Netherlands and Nigeria. It highlights significant cost savings in a number of settings. It also shows that compulsory programmes are more cost-effective as they reap the benefits and greater impact of full coverage of the student population.

For example, in Estonia a national sexuality education programme was introduced and linked with accessible, youth-friendly sexual and reproductive health services. Between 2001 and 2009 some 13 490 ‘health events’ were averted in the country, including nearly 2 000 HIV infections, at a potential lifetime cost of US$ 67 825 per patient, approximately 4 300 unintended pregnancies and more than 7 000 sexually transmitted infections.

The report also provides a detailed breakdown of the costs per learner of each completed sexuality education curriculum in the six countries. This ranges from US$ 6.90 in Nigeria to US$ 32.80 in the Netherlands. There are significantly higher costs in smaller pilot programmes, such as Kenya and Indonesia.

According to Mark Richmond, UNESCO’s Global Coordinator for HIV and AIDS, the landmark study gives an economic basis to the argument that sexuality education provides a key platform for HIV prevention amongst young people.

“We now have the data and analysis to make a stronger and better informed case for investing in school-based sexuality education programmes, particularly in those countries most affected by the epidemic and prioritized for attention in the new UNAIDS Strategy 2011-2015.”

Reducing the sexual transmission of HIV by half by 2015, including among young people, is one of the goals of the UNAIDS Strategy. However, the 2010 UNAIDS global report shows a critical gap in comprehensive prevention knowledge about HIV amongst this age group and that about 40% of all new HIV infections among adults occur among young people aged 15-24. Cost and cost-effectiveness adds to the growing recognition that school-based sexuality education has the potential to play a key role in improving young people’s knowledge for HIV prevention.

Inter-Agency Task Team on Education

Formed in 2002, the Inter-Agency Task Team on Education is convened by UNESCO and brings together UNAIDS Cosponsors, bilateral agencies, private donors and civil society partners to accelerate and improve a coordinated and harmonized education sector response to HIV.