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.

Treatment Action Campaign activists and UNAIDS HIV prevention commissioners march for scaled-up access to condoms.
Credit: UNAIDS/AFP Photo G. Guercia

A vibrant gathering took place outside the Treatment Action Campaign (TAC) in Site B in Khayelitsha on 4 May, as members of the public joined with high-level commissioners from the UNAIDS Commission on HIV Prevention to scale-up the use of condoms in communities most severely affected by HIV. Donning ‘HIV Positive’ t-shirts and dancing in unison to the music both on and off stage, Khayelitsha residents and others celebrated condoms as a barrier against the spread of the virus.

“Here in Khayelitsha, Treatment Action Coalition is empowering people living with HIV into leaders of the HIV prevention revolution,” said UNAIDS Executive Director Michel Sidibé, who also acknowledged the TAC’s role as a leading a “global movement for access to HIV treatment.”

Says TAC secretary-general, Vuyiseka Dubula, who is also a member of the UNAIDS Commission on HIV Prevention, “Our view at TAC is that condoms are by far the most effective tool to prevent HIV, and we have taken it upon ourselves team up with the City of Cape Town to increase accessibility.”

The partnership is now in its third year and, says Dubula, it has culminated in the distribution of at least one million condoms per annum in the region, with data from local clinics reporting an obvious drop in the incidence of sexual transmitting infections in the same period. But, she cautions, condom distribution needs to form part of a holistic approach to be most effective.

“We take condoms to people in their houses,” she explains. “We also consistently teach others about the correct use of condoms. We also bring supporting educational material in isiXhosa, we talk about the importance of testing, and we also share information about tuberculosis.”

An important figure at the gathering was a man known to most as either ‘Mr Condom’ or the ‘Condom King’. Hailing from Thailand, Mechai Viradaidya has been proactively distributing condoms for 37 years and, he says, his approach is all about the visibility of condoms—an approach that debunks the myths and gets rid of the taboo.

“Keep on mentioning condoms all the time, and let them be seen and be available everywhere,” he advises. “When I say they must be available, I don’t just mean physically, I mean mentally too. You have to have ‘condoms of the mind’ to really change behaviour.”

Viravaidya smiles and says he hands out condoms, “Absolutely everywhere except funerals.” He explains that he started bringing condoms out into the open in his native Thailand by having a condom-blowing competition amongst school teachers. “Whoever could blow the condom to the biggest size without it bursting was the winner,” he says.

He also set up the ‘cops and rubbers’ programme in Thailand by getting traffic police to sell and distribute condoms. He says that a condom is made of rubber like a tennis ball, “If you’re scared of condoms, be more scared of tennis balls—they contain a lot more rubber!”

Before TAC and the commissioners headed off on their march and on their community condom demonstrations, the crowd was treated to some words of wisdom from former President of Botswana Festus G. Mogae.

“I was the first African president to report to the UN that my country was in trouble,” he told those gathered. “We became the first to give out antiretroviral therapy for free. I have come here to greet you and inspire you because we are one.” He said that he had not come to preach but rather to ask everyone to carry on campaigning ‘until we win’.

“We will overcome,” he said to loud applause. “We need to all make it our business to ensure that no babies are born HIV positive. It is in our power to stop that from happening.”

UNAIDS Executive Director Mr Sidibé highlighted the significance of the event: “Today’s condom march shows that people with HIV are essential partners in movement for Positive Health, Dignity and Prevention.”

The condom march in Khayelitsha was part of a three-day programme convened by the UNAIDS High Level Commission on HIV Prevention in the Mother City. Other events included a panel discussion on social media and mobile technology in the prevention of HIV, and an historical gathering on Robben Island the following day where Desmond Tutu symbolically passed the baton of HIV activism to a group of youth leaders who, he hoped, would join him in stopping the spread of HIV.

UNAIDS Executive Director Michel Sidibé poses for a team photo with the young people taking part in the Skillz Street practice session at the Football for Hope Centre. Capetown, 4 May 2011.
Credit: UNAIDS/AFP Photo G. Guercia

During the meeting of the UNAIDS High Level Commission on HIV Prevention, which is taking place in South Africa this week, commissioners took time out to visit the Grassroot Soccer initiative in Capetown.

The commissioners visited the Football for Hope Centre during a Skillz Street practice session involving around 100 girls. Grassroot Soccer uses the power of soccer to educate, inspire, and mobilize communities to stop the spread of HIV. It builds basic life skills that help boys and girls adopt healthy behaviours and live risk-free.

UNAIDS Executive Director Michel Sidibé thoroughly enjoyed getting a chance to play football with the girls and was struck by the impact the centre is having on the community. “Here in Khayelitsha, the Football Centre for Hope is not just a project. It is a social meeting point for girls to protect themselves from HIV and become tomorrow’s football stars,” he said.

“Grassroot Soccer is restoring dignity and building self-esteem of young girls living in a challenging environment, transforming them into actors for the HIV prevention revolution.”

The delegation also had a chance to interact with the local staff and coaches to hear about how the programme and curriculum work, as well as the other types of HIV prevention and testing interventions they run in the community.

UNAIDS partnered with Grassroot Soccer in the development of the Skillz Curriculum which includes interactive activities for young people to learn about HIV and get a chance to practice the skills necessary for sustainable behaviour change. Topics in the curriculum include making healthy decisions, avoiding risks, building support networks, reducing stigma and discrimination, increasing knowledge about testing and treatment, addressing gender issues, and assessing values. Each of the commissioners received a set of Skillz Magazines and Skillz Coaches Training DVD.

In 2002 Tommy Clark, the founder and CEO, started Grassroot Soccer with friends who had played professional soccer together in Zimbabwe. They instinctively knew that soccer represented an opportunity in the fight against HIV. The organization has been operating in South Africa since 2006.

Learn more about Grassroot Soccer in this brief video overview:

Commitments made to transform the response to HIV at historic event on Robben Island

From left: Archbishop Desmond Tutu; Michel Sidibé, UNAIDS Executive Director; Dr Aaron Motsoaledi, South Africa Minister of Health.
Credit: UNAIDS/AFP Photo G. Guercia

Robben Island/Geneva, 4 May 2011—Archbishop Desmond Tutu has symbolically passed the baton to a new generation of young leaders focused on AIDS. The handover took place during an event held to inspire a transformation of the AIDS response which was convened by the Joint United Nations Programme on HIV/AIDS (UNAIDS) on Robben Island in South Africa.

The event joined together world renowned leaders from the UNAIDS High Level Commission on HIV Prevention with a group of young leaders who, in turn, presented the commissioners with a ‘call to action’ articulating the vision of the youth movement on HIV. The Commission on HIV Prevention was established by UNAIDS in 2010 to influence and lead social and political action aimed at galvanizing support for effective HIV prevention programmes.

“Today is about putting our heads and our hearts together to support a renewal of leadership and commitment in HIV prevention,” said Archbishop Tutu, co-chair of the Commission on HIV and long-standing AIDS advocate. “Bold and honest actions are needed and we look to the next generation of leaders to bring about positive change in attitudes and actions.”

The youth representatives convened recently in Mali at a youth leader’s summit on HIV where young people from across the world worked to find innovative ways of strengthening the links between youth and AIDS movements, notably through new media channels.

“Young people have the power to change the future and transform the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “A collective youth movement mobilised around HIV prevention which exchanges important information through new technologies and peer education will stop new infections.”

Archbishop Tutu called on the young participants to commit to taking forward a new generation of leadership in the AIDS response. He also called on the HIV Prevention Commission members to inspire and mentor them in their leadership role.

Commitments were also made by the Commissioners who pledged to take the transformation of the AIDS response forward in their respective sectors. Commissioner Earvin “Magic” Johnson announced by video message that his Foundation will be a founding partner of a global foundations fellowship programme for young people. Elena Pinchuk’s AntiAIDS Foundation announced a global competition for young innovators to develop social networking campaigns. The Global centre for innovation in mobile health and Cell Life pledged to work together with UNAIDS and mobile service providers to promote HIV prevention and behaviour change  dialogue through the use of mobile phones in at least five countries.

The event was held on Robben Island off the coast of Cape Town in South Africa where former president Nelson Mandela was incarcerated. The location is seen as a testimony to the human spirit, symbolising the power of change.

In the lead up to the 2011 Life Ball, UNAIDS participated in a kick off press conference in Vienna. This year’s Life Ball them is focused on the element of “Air”, following the quadrennial cycle of the four elements started in 2008.

The event will be held at Vienna’s landmark City Hall and more than 40 000 people are expected to attend. Focusing on Eastern Europe, the Life Ball hopes to raise awareness on such issues as overcoming stigma and discrimination against people living with and affected by HIV.

Mariangela Bavicchi-Lerner, Chief Resource Mobilization, participated on behalf of the UNAIDS alongside Gery Keszler, CEO of the Life Ball and Chairman of AIDS LIFE—the organization that produces the event. Fashion designers Dean and Dan Caten, of DSquared2 were also in attendance. The 2011 AIDS Solidarity Gala and Life Ball will take place on 21 May 2011.