A version of this story also appears at who.int

Credit: WHO

Drug resistance is becoming more severe and many infections are no longer easily cured, leading to prolonged and expensive treatment and greater risk of death, warns the World Health Organization (WHO) on World Health Day, 7 April 2011.

Under the theme "combat drug resistance", WHO calls for urgent and concerted action by governments, health professionals, industry, civil society and patients to slow down the spread of drug resistance, limiting its impact today and preserving medical advances for future generations.

Drug resistance is a natural process in which microorganisms acquire resistance to the drugs meant to kill them. With each new generation, the microorganism carrying the resistant gene becomes ever more dominant until the drug is completely ineffective. Inappropriate use of infection-fighting drugs (underuse, overuse or misuse) causes resistance to emerge more quickly.

On the brink of losing miracle cures

“The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures,” said WHO Director-General Dr Margaret Chan. She added, “The trends are clear and ominous. No action today means no cure tomorrow.”

Measures to combat drug resistance

WHO has published a policy package that sets out the measures governments and their national partners need to combat drug resistance. These include:

• Develop and implement a comprehensive, financed national plan
• Strengthen surveillance and laboratory capacity
• Ensure uninterrupted access to essential medicines of assured quality
• Regulate and promote rational use of medicines
• Enhance infection prevention and control
• Foster innovation and research and development for new tools.

Resistance detected in a number of diseases

According to latest WHO figures, at least 440 000 of new cases of multidrug resistant-tuberculosis (MDR-TB) emerge each year, and by the end of 2010, 69 countries had reported extensively drug-resistant tuberculosis (XDR-TB). Resistance is also emerging to the antiretroviral drugs used to treat people living with HIV.

Getting everyone on the right track

Dr Mario Raviglione, Director of WHO Stop TB Department, who has been leading the preparations for World Health Day 2011, called for measures against drug resistance to be strengthened and implemented urgently. He added, “New collaborations, led by governments working alongside civil society and health professionals, if accountable, can halt the public health threat of drug resistance."

Speakers at the Heineken HIV/AIDS Symposium 2011

Thirty years into the epidemic, is business a full partner in the AIDS response in Africa? A recent symposium hosted by Heineken N.V. in Amsterdam highlighted that there are many ways the private sector can contribute.

With Sharing responsibilities in the ‘World of Work’ in Africa as its theme, the symposium took stock of current business practices in Africa—in the workplace and beyond—and explored ways around how business good practices can be scaled up. Access to HIV treatment, resistance to treatment and gaps in funding were three of the main key issues discussed.

“There are many reasons why HIV is a smart investment for businesses,” said Dr Hedia Belhadj, UNAIDS Director Partnerships: “Addressing HIV in the workplace creates trust among staff and helps sustain productivity. Addressing HIV more broadly helps to boost consumer markets and bring about economic growth and reduce poverty.”

The symposium brought together representatives from the government of The Netherlands, including AIDS Ambassador Dr Marijke Wijnroks, international and non-governmental organizations, the public health community and the private sector.

Mr Ben Knapen, the Netherlands Minister for European Affairs and International Co-operation stressed the importance of partnering with the private sector to respond to HIV. “My government believes that public-private partnerships are an important tool in the response to HIV. Bringing together partners from both the public and private sectors creates the synergy and leverage we need in order to step up our efforts,” said Mr Knapen.

Private sector’s knowledge, resources, capacity and contacts are valuable resources that can contribute to an effective response to AIDS. By using their corporate communications and marketing skills, businesses can help raise AIDS awareness and promote behavioral change among employees, their families and communities. Companies can incorporate prevention messages that promote gender equality in existing communication platforms as well as instating zero tolerance policies to eliminate stigma and discrimination.

Private sector to become full partner in the global response

Two out of three people living with HIV go to work each day, according to UNAIDS. So the workplace has a vital role to play in mitigating the impact of the AIDS epidemic and facilitating access to HIV prevention, treatment, care and support. Workers that are living with HIV and taking effective treatment can lead healthy, productive lives for many years. Heineken—which employs more than 70 000 people worldwide—realized the value of this.

In the early 1980’s, the company began building clinics and training staff to provide health care to employees. In 2001 it adopted and implemented its HIV workplace policy which contributed to improve the response to HIV among employees and their families.

Today, the brewing group's workplace programmes include a “know your status” campaign with voluntary counselling and testing events and training by peer health educators, who also raise awareness about HIV to pupils in local schools.

AIDS committees have been established in nine breweries to also oversee education and condom distribution campaigns, information sessions for people living with HIV and awareness events around World AIDS Day.

Heineken provides treatment for all employees living with HIV and further, it guarantees treatment for employees and their families for life, regardless of whether they are still employed at the company.

Not all companies are willing to or capable of making such a commitment. The question of sustainability and the long term commitment that the company has to shoulder, given the little likelihood for national services to replicate the quality of HIV service delivery, was seen by participants as a major obstacle in implementing workplace policies related to HIV.

Dr Belhadj outlined the importance of the new ILO Standard on HIV/AIDS and the world of work. It provides a platform for business to promote healthy workplaces by defining roles and responsibilities at all levels of policy and decision-making processes, implementation, and evaluation of HIV programmes in the workplace.

Participants agreed that, to become full partners in the AIDS response, businesses need to engage in high level advocacy. The private sector can use their weight to promote accountability and transparency by reporting on money spent on social welfare programmes. They can break the upward trajectory of costs of drugs, supplies and delivery and participate in innovative public-private partnerships on research and development.

The Tanzania Youth Alliance (TAYOA) is a national, non-profit organization that empowers young people to engage in meaningful activities that improve their quality of life.
Credit: UNAIDS/AFP - Siegfried Modola

During a visit to the Tanzanian Youth Alliance (TAYOA), a national non-profit organization based in Dar Es Salaam, UN Deputy Secretary-General Dr Asha-Rose Migiro and UNAIDS Executive Director Michel Sidibé praised the young people for the extraordinary responsibility they have shown in addressing HIV.

TAYOA operates a National AIDS Helpline to respond to queries from young people on a range of HIV-related issues. Individuals call the Helpline free of charge using a landline or mobile phone. Medical students volunteer their time to counsel other youth across the country.

Starting with single phone line in 2001, the organization now runs eight lines for 12 hours a day. One thousand callers, on average, are counselled daily, and one million callers have been reached since 2008. Information is provided confidentially.

“Young people like you don’t want to sit around and be passive beneficiaries of programmes—they want to be dynamic agents of change!” said Mr Sidibé, addressing an audience of more than 200 youth at TAYOA headquarters. “What you are doing here to create space for young people is truly inspirational,” he added.

TAYOA’s National Helpline is the result of a unique public-private partnership between the Government of Tanzania, the United States Centers for Disease Control and six national phone operators: TiGO, Vodacom, Airtel, TTCL, Sastel and Zantel.

“In an era of real-time communications, this kind of strategic partnership is the lifeblood of effective HIV responses,” said the UN Deputy Secretary-General, after touring the TAYOA grounds. “I salute the young people who are working on this impressive project,” she added.

According to TAYOA staff, callers ask a range of questions around condom use, sexual relationships, HIV testing, antiretroviral treatment and the prevention of HIV transmission from mother to child. More than 200 young people support the National AIDS Helpline and other TAYOA programmes, including youth outreach clubs and an information technology project.

“One of the great lessons we have learned in our journey is the need to embrace and cultivate a culture of volunteerism in our society,” said Peter Masika, Country Director for TAYOA. “We have learned that when young people are meaningfully engaged, they can take charge and act to improve their own quality of life, and the lives of their friends.”

Over the past decade, young people in Tanzania appear to have adopted safer sexual behaviours: according to a UNAIDS study, HIV prevalence among Tanzanian youth aged 15 to 24 fell by more than 25% between 2001 and 2009.

Credit: UNAIDS

In developing countries one of the major challenges for universal access to treatment is access to affordable commodities. Two events in Cape Town are giving an opportunity for discussion, reflection and developing a strategy for improving access to quality and affordable drugs in Africa.

The International Conference on local pharmaceutical production in Africa is taking place 4-6 April 2011. Bringing together politicians, the pharmaceutical industry and development partners it’s an opportunity for exchange and collaboration—which is essential for promoting local pharmaceutical production. Under discussion are a wide range of issues including access to essential medicines, intellectual property rights, technology transfer as well as the use of TRIPS-flexibilities and the harmonization of drug regulation.

Representatives from the regional intergovernmental organizations the East African Community and the Southern African Development Community are being joined by representatives from the Indian pharmaceutical industry, as well as UNDP and WHO. They were welcomed by Stefano Bologna, UNIDO Representative; Mr Dieter Haller, German Ambassador to Pretoria; and Mr Olajide, from the African Union Commission. Participants also include Mr Anand Grover, UN Special Rapporteur on the Right to Health, and Ms Ellen T’Hoen executive director of the Medicines Patent Pool.

In his keynote address at the opening, UNAIDS Deputy Executive Director, Programme Paul De Lay said that local production of high-quality pharmaceuticals in Africa is an opportunity to sustain the AIDS response over the longer term and put products nearer to those who need them.

“But it requires a strong regulatory environment that can attract private sector investments for the manufacture of medicines within Africa. Domestic production could flourish, just as we have seen in Asia and Latin America,” he said.

“Building regulatory capacity is also critical to facilitate timely access to quality, safe and efficacious medicines,” Dr De Lay added.

Southern African Generic Medicines Association launched

The conference was preceded on 4 April by the public launch of the Southern African Generic Medicines Association (SAGMA). This non-profit association hopes to promote collaboration within the pharmaceutical sector in order to achieve self-sufficiency and reliability in the local production and provision of affordable, efficacious, quality generic medicines in the Southern Africa Development Community.

UNAIDS Deputy Executive Director, Programme Paul De Lay gave one of the keynote speeches at the launch. He spoke of the power of a “pan-African vision and regulatory system” emerging, which would allow for fewer delays in authorisation of medicines, better quality control, stronger support to innovation and a more sustainable response to HIV.

“SAGMA has an essential role to play in supporting the development of a pharmaceutical regulatory plan for Africa that will support universal access to treatment,” said Dr De Lay.

Dr De Lay went on to describe how SAGMA could support countries with “implementation of TRIPS, innovative licensing schemes and the Medicines Patent Pool to keep prices going down and ensure that new generations of good quality drugs become available.”

Ms Joy Phumaphi the Executive Secretary of the African Leaders Malaria Alliance (ALMA) in Botswana, also gave a keynote address. ALMA is an alliance of African Heads of State and Government working to end malaria-related deaths. It was founded by the leaders in order to use their individual and collective power across country and regional borders.

Two panel discussions were also held to share experiences about pharmaceutical manufacturing in southern Africa. Speakers included representatives from private sector pharmaceutical companies.

UNAIDS Executive Director Michel Sidibé (left), Tanzanian President Jakaya Mrisho Kikwete (centre) and UN Deputy Secretary-General Dr Asha-Rose Migiro at the State House in Dar Es Salaam on 4 April 2011.

In a joint mission to the United Republic of Tanzania, UN Deputy Secretary-General Asha-Rose Migiro and UNAIDS Executive Director Michel Sidibé met with high-level government officials on Monday, including the President, Prime Minister, Minister of Health and Social Welfare, and head of the Tanzania Commission for AIDS (TACAIDS).

“Through strong leadership and political will Tanzania has had great success in its response to HIV,” said Dr Asha-Rose Migiro, in a meeting with President Jakaya Mrisho Kikwete at the State House in Dar Es Salaam.

An estimated 52% of people in Tanzania who need antiretroviral treatment are now receiving it, up from virtually zero coverage in 2004. Coverage of services to prevent mother-to-child transmission of HIV reached 70% in 2010, up from 10% coverage in 2004.

“I want your legacy to be zero new HIV infections among children by the year 2015,” said Mr Sidibé, in his meeting with President Kikwete. “I want Tanzania to be one of the first countries to eliminate HIV transmission from mother to child,” he added.

President Kikwete underscored that HIV was a high priority in the country. However he expressed concerns over sustainability of the AIDS response, particularly in the context of the global economic downturn. To address these concerns, the government recently created an AIDS Trust Fund with the aim of reducing the national funding gap for AIDS.

Mr Sidibé echoed the President’s concerns over the lack of predictable and long-term funding for HIV responses. About 96% of people on HIV treatment in the African continent are currently funded through external sources, he said. Mr Sidibé urged Tanzanian authorities to lead a debate at this year’s General Assembly High Level Meeting on AIDS over country ownership of HIV responses.

(L to R): UNAIDS Deputy Executive Director, Management and External Relations, Ms Jan Beagle; Hon Rodger Samuel, Minister in the Office of the Prime Minister responsible for HIV; Dr Ernest Massiah, Director, UNAIDS Caribbean; Mr Sam Condor, Deputy Prime Minister and Minister of Foreign Affairs of St Kitts and Nevis; Mr Ainsley Reid, GIPA, Jamaica; Ms Angelica Hunt, Ag UN Resident Coordinator; and Ms Izola Garcia, UNAIDS Coordinator for Trinidad and Tobago.

Representatives from government, civil society, people living with HIV, UN agencies and development partners from across the Caribbean met in Port of Spain, Trinidad and Tobago, to review progress made towards achieving universal access to HIV prevention, treatment, care and support targets. The two-day meeting held from 23-24 March was convened by UNAIDS in collaboration with partners in the lead up to the UN High Level Meeting on AIDS, which will take place in June 2011.

“This is a unique opportunity for everyone who is part of the AIDS response day after day to reflect and take stock of where we are on our shared journey,” said UNAIDS Deputy Executive Director, Management and External Relations, Jan Beagle.

Political leaders were candid about the challenges and underscored the need to engage young leaders and do things differently as the AIDS response enters a new era and moves towards reaching zero new infections, zero discrimination, and zero AIDS-related deaths.

“Fear, denial, ignorance, stigma and discrimination are still very prominent in the region. It is a barrier to condom use, even accessing HIV treatment and care,” said Rodger Samuel, Minister in the Office of the Prime Minister, Trinidad and Tobago. “The old approaches do not seem to be working, especially with the new generation. If we do not get our youth involved, ‘getting to zero’ will be an immensely hard task.”

There are an estimated 260 000 people living with HIV in the Caribbean. Close to half of people in need of antiretroviral treatment are receiving it. Overall, HIV now affects more women than men in the region. However, there is considerable variation between countries. For example, 60% of people living with HIV in the Bahamas are women. But in Cuba and Suriname, 69% of people living with HIV are men. AIDS remains the leading cause of death in people aged 20-59 years old.

Participants acknowledged important progress in the region to date, including a 43% reduction in AIDS-related mortality between 2001 and 2008, and an 18% reduction in new HIV infections among children during the same time period. There has been significant expansion of programmes to prevent mother-to-child HIV transmission of HIV, with four countries that reaching 95% coverage.

But stigma and discrimination, homophobia and a punitive legal environment continue to undermine efforts to reach universal access goals towards HIV prevention, treatment, care and support across the Caribbean. There are 11 countries in the region that criminalize sex between people of the same sex, and 13 that criminalize sex work. Five countries, territories and areas continue to impose restrictions on the entry, stay and residence of people living with HIV.

“The HIV response shines a spotlight on inequality and violations of human rights, and compels us to act,” said Ms Beagle. “We must remove punitive laws that are blocking access to critical HIV services. The law should work for the HIV response, not against it.”

Participants also discussed the need to increase investment in stigma and discrimination reduction programmes to secure the rights of people living with HIV. Ainsley Reid, Coordinator for the Greater Involvement of People Living with HIV, Jamaica, underscored this by highlighting that “people living with HIV need more than medicines.” 

“I know people who have died with the medicines in their hands. What we really need is social protection, including food, employment, housing, etc. This is what it takes to move beyond ‘victim mode’ and have empowerment and meaningful involvement,” he added. 

Participants during the universal access consultation that took place in Port of Spain, Trinidad and Tobago. 23-24 March 2011

Civil society reported on the outcomes and conclusions of a one-day meeting which they held prior to the universal access consultation. Representatives called for the removal of punitive laws that block HIV responses and violate human rights. The need for intensified political and community action to take on the continued taboo around issues related sexuality was also stated. Civil society also emphasized the need to train healthcare workers on ethics and confidentiality. A call was made for regional negotiations to drive down the price of medicines.

Changes in the development environment, including signs of reductions in funding flows, was a backdrop to the discussions during the two days. During the last decade the Caribbean region received more than US$ 1.3 billion in external funding for HIV. While some countries already fund their national HIV programmes entirely from domestic resources, others will be under increasing pressure to reduce programme delivery costs and secure new resources as current sources of funding decline.

“It will be imperative to clearly identify where we can make efficiencies in the region, and be ruthlessly honest about dropping what doesn’t yield us results,” said Ernest Massiah, Director of the UNAIDS Regional Support Team for the Caribbean in his remarks during the opening ceremony.

In lead-up to June High Level Meeting, progress report presents overview of efforts needed to help countries achieve universal access to HIV services and zero new HIV infections, discrimination and AIDS-related deaths

Launch of the Report of the Secretary-General. Nairobi, Kenya, 31 March 2011.
Credit: UNAIDS/AFP - S.Maina

NAIROBI, 31 March 2011—Thirty years into the AIDS epidemic, investments in the AIDS response are yielding results, according to a new report released today by United Nations Secretary-General Ban Ki-moon. Titled Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths, the report highlights that the global rate of new HIV infections is declining, treatment access is expanding and the world has made significant strides in reducing HIV transmission from mother to child.

Between 2001 and 2009, the rate of new HIV infections in 33 countries—including 22 in sub-Saharan Africa—fell by at least 25%. By the end of 2010, more than 6 million people were on antiretroviral treatment in low- and middle-income countries. And for the first time, in 2009, global coverage of services to prevent mother-to-child transmission of HIV exceeded 50%.

But despite the recent achievements, the report underscores that the gains are fragile. For every person who starts antiretroviral treatment, two people become newly infected with HIV. Every day 7 000 people are newly infected, including 1 000 children. Weak national infrastructures, financing shortfalls and discrimination against vulnerable populations are among the factors that continue to impede access to HIV prevention, treatment, care and support services.

The Secretary-General’s report, based on data submitted by 182 countries, provides five key recommendations that will be reviewed by global leaders at a UN General Assembly High Level Meeting on AIDS, 8–10 June 2011.

“World leaders have a unique opportunity at this critical moment to evaluate achievements and gaps in the global AIDS response,” said Secretary-General Ban Ki-moon at the press briefing in the Kenyan capital. “We must take bold decisions that will dramatically transform the AIDS response and help us move towards an HIV-free generation.”

United Nations Secretary-General Ban Ki-moon and UNAIDS Executive Director Michel Sidibé with Rebecca Auma Awiti, mother of three children and field coordinator with the non-governmental organization Women Fighting AIDS in Kenya who told her story at the press conference.
Credit: UNAIDS/AFP - S.Maina

“Thirty years into the epidemic, it is imperative for us to re-energise the response today for success in the years ahead,” said UNAIDS Executive Director Michel Sidibé, who joined Mr Ban for the launch of the report. “Gains in HIV prevention and antiretroviral treatment are significant, but we need to do more to stop people from becoming infected—an HIV prevention revolution is needed now more than ever.”

Rebecca Auma Awiti, a mother living with HIV and field coordinator with the non-governmental organization Women Fighting AIDS in Kenya told her story at the press conference. “Thanks to the universal access movement, my three children were born HIV-free and I am able to see them grow up because of treatment access,” she said.

Mobilizing for impact

In the report there are five recommendations made by the UN Secretary-General to strengthen the AIDS response:

• Harness the energy of young people for an HIV prevention revolution;
• Revitalize the push towards achieving universal access to HIV prevention, treatment, care and support by 2015;
• Work with countries to make HIV programmes more cost effective, efficient and sustainable;
• Promote the health, human rights and dignity of women and girls; and
• Ensure mutual accountability in the AIDS response to translate commitments into action.

The Secretary-General calls upon all stakeholders to support the recommendations in the report and use them to work towards realizing six global targets:

• Reduce by 50% the sexual transmission of HIV—including among key populations, such as young people, men who have sex with men, in the context of sex work; and prevent all new HIV infections as a result of injecting drug use;
• Eliminate HIV transmission from mother to child;
• Reduce by 50% tuberculosis deaths in people living with HIV;
• Ensure HIV treatment for 13 million people;
• Reduce by 50% the number of countries with HIV-related restrictions on entry, stay and residence; and
• Ensure equal access to education for children orphaned and made vulnerable by AIDS.

As international funding for HIV assistance declined for the first time in 2009, the report encourages countries to prioritize funding for HIV programmes, including low- and middle-income countries that have the ability to cover their own HIV-related costs. It also stresses the importance of shared responsibility and accountability to ensure the AIDS response has sufficient resources for the coming years.

The report and more information about the High Level Meeting on AIDS can be found online at: unaids.org/en/aboutunaids/unitednationsdeclarationsandgoals/2011highlevelmeetingonaids/

Credit: UNAIDS/P. Virot

The World Health Organization (WHO) has published its first ever list of 30 priority medicines for maternal and child health. The list includes medicines for children living with HIV as well as a triple combination of drugs to prevent mother-to-child transmission of HIV.

Compiled by experts in maternal and child health and medicines, the list is based on the WHO Model List of Essential Medicines and the latest WHO treatment guidelines. It provides a concrete way forward in striving to achieve global health goals[i].

The health situation for many women and children across the globe remains precarious. Despite a decline since 2004, in 2009 an estimated 260 000 children under the age of 15 died from AIDS-related illness[ii]. Every day some 1000 women lose their lives due to complications during pregnancy and childbirth. Most of these deaths can be prevented if the correct medicines in the correct formulations are prescribed and used in the correct way.

Many of the medicines can be administered quickly and easily. For example, a single injection of oxytocin can stop a woman bleeding to death if she haemorrhages after childbirth.

Preventing mother-to-child transmission of HIV

The WHO-recommended drug regimen of prolonged use of combination of three antiretroviral (ARV) drugs to prevent mother-to-child transmission of HIV is also highlighted in the priority medicines list.

Positive results from a WHO-led study that were published in The Lancet in January 2011 showed that giving pregnant women living with HIV a combination of three ARV drugs during the last trimester of pregnancy, through delivery and six months of breastfeeding can reduce the risk of their baby being infected with HIV by more than 40% compared to the use of a single-dose ARV drug regimen which stopped at delivery as had been recommended by WHO since 2004.

Children and HIV

Without effective HIV treatment, an estimated one third of infants living with the virus will have died by one year of age, and about half will have died by two years of age. The list includes recommendations in the area of paediatric AIDS. Appropriate doses of the right combinations of antiretrovirals are critical to reducing child deaths from AIDS-related illness.

According to WHO, additional research and development is also urgently needed for appropriate products for prevention and treatment of tuberculosis, particularly in children living with HIV.    

Despite these pressing needs, surveys conducted in 14 African countries show that children's medicines are available in only 35% to 50% of pharmacies and drug stores[iii]. There is also a lack of awareness that children need different medicines from adults. When adult medicines are fractioned into smaller parts for children, the dose can be inaccurate and the medicine hard to swallow.

WHO recommends that, wherever possible, medicines for children should be provided in doses that are easy to measure and easy to take. There should also be steps to ensure that medicines are appropriate for the intended setting.

"Medicines produced in liquid form are more expensive than tablets or powders and are also more difficult to store, package, and transport, due to their bulk, weight and need for refrigeration. The list we have drawn up tells manufacturers exactly what they should be producing to meet countries’ needs," said Dr Hans V. Hogerzeil, Director of WHO's Department for Essential Medicines and Pharmaceutical Policies.

The release of the list of top 30 medicines to save mothers and children was timed to coincide with the meeting of the 18^th Expert Committee on the Selection and Use of Essential Medicines. The meeting took place in Ghana, 21-25 March 2011. “This list is designed to help countries prioritize, so that they focus on getting the most critical things available and save the most lives," said Dr Elizabeth Mason, Director of WHO's Department of Maternal, Newborn, Child and Adolescent Health.

[i] Millennium Development Goals 4, 5 & 6: Reduce child mortality; Improve maternal health; Combat HIV/AIDS, malaria and other diseases.

[ii] UNAIDS global report 2010

[iii]  Jane Robertson, Gilles Forte, Jean-Marie Trapsida & Suzanne Hill. What essential medicines for children are on the shelf? Bulletin of the World Health Organization 2009;87:231-237. doi: 10.2471/BLT.08.053645

A 40-foot converted shipping container making its way around European cities is vividly highlighting the work of North Star Alliance. Credit: UNAIDS

A 40-foot converted shipping container making its way around European cities is vividly highlighting the work of North Star Alliance. This public-private partnership is committed to building a network of roadside clinics at transport ‘hotspots’ in Africa to provide long-haul truck drivers, sex workers and surrounding communities with access to basic health care.

This week the North Star Alliance road show, with its container-based model wellness centre, arrived in Geneva. UNAIDS and World Health Organization staff were able to see for themselves exactly how these centres operate. Many took advantage of the opportunity to receive free medical checks, including blood pressure  testing.

From HIV prevention to antihistamines

The broad range of services on offer in a typical wellness centre includes condom distribution, treatment for sexually transmitted infections, information on HIV prevention and nutrition, basic eye tests, malaria treatment and even getting antihistamines for the common cold. Most centres also offer HIV counselling and testing and access to a behaviour change communication specialist. North Star is planning to expand its services to include greater support for antiretroviral therapy and tuberculosis screening.

There are now 22 wellness centres in 10 countries in east and southern Africa. By the end of 2014 there will be 100 such centres covering 85% of the major transport corridors on the continent. 

In the field, the shipping containers are placed at border posts or transit towns where truckers congregate and are open late, when drivers have parked for the night and sex work tends to take place. In general mobile workers, who often have to spend long periods away from their families, may have multiple partners and use the services of sex workers.

A model partnership

A broad range of services are on offer including condom distribution, treatment for sexually transmitted infections, information on HIV prevention and nutrition, basic eye tests, and malaria treatment. Credit: UNAIDS

North Star Alliance is an independent non-governmental organization, supported by five core partners: the express distribution company TNT, the International Transport Workers’ Federation, the World Food Programme, UNAIDS and ORTEC, a large provider of logistics software. It is seen as a model of public-private partnership.

According to Robin Jackson, UNAIDS’ representative on the board of North Star; “This is one of the best public-private partnerships I’ve seen. It works well. Each partner brings specialist expertise and knowledge to make a strong and cohesive intervention that’s really making a difference. ”

Minister of Heath of Kyrgyzstan, Sabyrbek Dzhumabiekov (left) and, UNAIDS Deputy Executive Director, Programme, Paul De Lay addressing participants at the universal access consultation. Kiev, 17-18 March 2011

Insufficient investment in programmes to prevent HIV infection among key populations at higher risk is hampering efforts to achieve universal access to HIV prevention, treatment, care and support in Eastern Europe and Central Asia. That’s according to participants at the regional consultation that took place in Kiev, Ukraine on 17-18 March 2011.

Government and civil society representatives from 30 countries across the region participated in the universal access consultation. The objective was to discuss gaps in the region’s response to HIV as well as identify key priorities for future action.

“Eastern Europe and Central Asia remain far from achieving universal access, in spite of significant efforts,” said Dr Denis Broun, Director, UNAIDS Regional Support Team, Europe and Central Asia.

The region has seen progress in preventing mother-to-child HIV transmission. HIV treatment coverage has been slowly increasing in recent years. Yet only one out of four people needing treatment are receiving it—the lowest coverage rate in the world.

Insufficient availability of treatment as well as prevention programmes—especially for the key populations at higher risk of HIV such as people who use drugs, men who have sex with men, prisoners and sex workers—were seen as the major gaps in the region leading to the increase of new infections. 

One of the discussions centred around the significant dependence that the region has on international financial support, specifically in the form of Global Fund grants. Participants stressed that national funding levels were low and called for countries to increase their domestic investment in the AIDS response. “Countries should not wait until funding from the Global Fund and other international donors ends. Sustainability of the HIV prevention, treatment, care and support should rely on national budgets,” stated participants in their final recommendations. “Governments should look at AIDS funding not as ‘spending’ but as investing in the economy, in the workforce and the future."  

Representatives of non-governmental organizations noted that, in general, civil society is not involved in budgetary decision-making when it comes to allocation of government funds. As a consequence, the effectiveness of the overall AIDS response remains low due to the limited capacity of the State to respond to the needs of people at higher risk of infection.

According to participants, there is a lack of sufficient HIV prevention programmes providing information to young people, raising awareness and promoting condom use to prevent sexual transmission of HIV. The existence of HIV-related travel restrictions, criminalization of HIV transmission and same-sex relations and the repressive police practices towards people who inject drugs were identified as significant barriers to establishing relationships of trust with people most-at-risk. Participants also agreed on the need to create legal environments to facilitate the intake of HIV prevention services by populations at higher risk of infection.

The recommendations made by participants will be included in the universal access progress report that will be presented at the United Nations General Assembly High Level Meeting on AIDS that will take place in New York in June 2011.

“The HIV situation in the region is critical. By contributing to the recommendations at a time when they are developed, we have a chance to ensure that the voice of people living with HIV is heard,” said Vladimir Zhovtyak, head of the Eastern European and Central Asia Network of People Living with HIV.