(From left): Michel Sidibé, UNAIDS Executive Director; Irene Khan, human rights activist; Michelle Bachelet, UN Women Executive Director; Babatunde Osotimehin, UNFPA Executive Director. 24 February 2011.
Credit: UNAIDS/B. Hamilton

HIV is the leading cause of death among women of reproductive age worldwide. For this to change, the global HIV response must fully recognize the significant role that gender inequality plays in increasing women and girls’ vulnerability to HIV.

At a high-level consultation, jointly organized by UNAIDS, UNFPA and UN Women, influential experts, leaders and advocates came together to discuss how sexual and reproductive health, and the rights of women and girls living with HIV can be enhanced and protected.

The event which took place on 24 February, was co-hosted by Michel Sidibé, Executive Director of UNAIDS, Michelle Bachelet, UN Women’s Executive Director, and UNFPA’s Executive Director, Babatunde Osotimehin.

Concerns were expressed about the reported violations of the sexual and reproductive rights of women and girls living with HIV, which impact on their desire to have children, as well as their access to prevention, treatment, care and support. Participants described the experience of some young women living with HIV who face stigma and discrimination when accessing HIV and sexual and reproductive health services. Examples were shared of HIV positive women who were advised not to engage in sexual relationships and scolded when seeking health care when pregnant, which presented a barrier to them accessing prevention of mother-to-child HIV transmission and safe delivery services.

Participants identified strategic opportunities to protect and promote sexual and reproductive health and rights, including through improved and sustained investment in women and girls living with HIV. There was consensus that a gender-sensitive AIDS response can help countries move towards universal access to HIV prevention, treatment, care and support services and the Millennium Development Goals. This approach is that recommended by UNAIDS and in line with the UNAIDS Agenda for Women and Girls , and the UNAIDS Strategy 2011-2015 .

Arguing for the better integration of HIV in development plans, Dr Nafsiah Mboi, Secretary of the National AIDS Commission, Indonesia emphasized, “HIV is not a health issue, it’s a development issue.”

During the consultation’s opening session, Michel Sidibé spoke of the UNAIDS Strategy and the Agenda for Women and Girls, reinforcing UNAIDS commitment to making gender equality and women’s health and rights a core part of the global AIDS response. He encouraged women and girls living with HIV to raise their voices for social change, despite the risk of stigma, discrimination and social exclusion:

"We must take AIDS out of isolation and provide young girls with opportunities to negotiate their sexual relationships and receive sexuality education so that they can protect themselves from infection,” said Mr Sidibé. “If we don't do this, our vision of zero new infections will remain a dream."

Sharing UN Women’s response to these fundamental issues of gender inequality, Michelle Bachelet contended, "we need to integrate not only services provided but also ongoing political and social movements, including the HIV and women's empowerment movements."

Ms Bachelet also argued that human rights alone is not a sufficient argument for investing in women and HIV, rather, “what is needed is a political, economic and social case.” She also stressed the importance of all involved working together in a coordinated way.

Dr Osotimehin commented on the importance of strengthening the rights of women and girls. “Empowering young people, particularly girls and women, living with HIV to defend their rights and have access to education, information, and services would be a major revolution,” he said.

The outcomes of the discussion will serve as input for the 55^th meeting of the Commission on the Status of Women as well as the 2011 High-Level Meeting on AIDS in June.

Commission on the Status of Women

The 55^th session of the CSW runs until 4 March 2011. Representatives from Member States, UN entities, and ECOSOC-accredited non-governmental organizations from all regions of the world are gathered to evaluate progress on gender equality, identify challenges, set global standards and formulate concrete policies to promote gender equality and advancement of women worldwide.

(From left) UNAIDS Executive Director Michel Sidibé and the President of the 65th session of the United Nations General Assembly Mr Joseph Deiss. 25 February 2011.
Credit: UNAIDS/B. Hamilton

The President of the 65th session of the United Nations General Assembly Mr Joseph Deiss convened the first formal meeting on the preparations for the 2011 High Level Meeting on AIDS with UNAIDS Executive Director Michel Sidibé and the event co-facilitators.

The General Assembly President recently appointed Ambassador Gary Francis Quinlan, Permanent Representative of Australia and Ambassador Charles Thembani Ntwaagae, Permanent Representative of Botswana as co-facilitators of the high level review which will take place 8-10 June 2011. They are tasked to hold timely, open, transparent and inclusive consultations with all Member States, with a view to adopting a concise and action-oriented declaration as an outcome of the high level review.

Mr Sidibé thanked the General Assembly President for his personal leadership to ensure the success of the forthcoming 2011 High Level Meeting on AIDS.

Mr Deiss has urged countries to participate in the event. “I call on all nations to unite at the High Level Meeting on AIDS. Together we can chart the future of the AIDS response,” wrote Mr Joseph Deiss.

Remembering the 33.3 million people living with HIV, UNAIDS Executive Director Michel Sidibé is aware of the significance of June’s gathering: “The decisions made at this High Level Meeting on AIDS will change lives today and for future generations.”

Friday’s high level discussion included exploration of the themes of the roundtable sessions as well as high level representation from all regions and member states.

As part of the preparatory process for the June gathering, the President of the General Assembly will hold an informal interactive civil society hearing on 8 April 2011. To discuss this process and the hearing, the President and Mr Sidibé also met with members of civil society.

The cause of promoting gender equality and meeting the needs of women and girls has taken an historic step forward. A new organization—UN Women—was officially launched yesterday at the UN General Assembly Hall in the presence of leaders from the worlds of politics, entertainment, business and the media.  

The new body aims to provide a dynamic and powerful voice at national, regional and global levels for women’s rights and equality. It is also tasked with ensuring that the UN system lives up to its own commitments to gender equality, making new opportunities for women and girls central to UN programmes.

The launch event, called Honouring the Past – Envisioning the Future for Women and Girls, was hosted by Michelle Bachelet, UN Women’s Executive Director and former President of Chile.

Speakers included UN General Assembly President Joseph Deiss; the President of the UN Women Executive Board and former Foreign Minister of Nigeria, Ambassador Joy Ogwu; Nepalese activist Bandana Rana, and former Commander of the all-female Formed Police Unit in Liberia Rakhi Sahi.

Ms Bachelet told the gathering that the importance of UN Women could not be underestimated as “the neglect of women’s rights means the social and economic potential of half the population is underused.”

“It is no longer acceptable to live in a world where young girls are taken out of school and forced into early marriage, where women’s employment opportunities are limited, and where the threat of gender-based violence is a daily reality—at home, in the street, at school and at work,” she said.

“I look forward to working with UN Women which will be a powerful voice for women and girls and help move the AIDS response forward,” said UNAIDS Executive Director Michel Sidibé who attended the event. “By teaming up and working on common goals the AIDS movement and the women’s movement can dramatically reduce the impact of HIV on women and their families.”

Ensuring that women’s needs are met is not only beneficial to women themselves but to society as a whole as untapped potential can be unleashed. However, widespread gender inequality persists as women often face discrimination, are sometimes denied access to education and health services and generally have fewer resources than men. Many women also suffer from violence which can leave them vulnerable to HIV if their ability to make healthy decisions about how to protect themselves against the virus is hampered.

It is hoped that UN Women, with its wide-reaching mandate, will have a dramatic impact on improving the lives of the world’s women.

The following video documentary The journey of women’s rights 1911-2011 was shown at last night’s event.

UNAIDS Director, Regional Support Team for Asia and Pacific Steve Kraus and First Lady of Cambodia, Lok Chumteav Bun Rany Hun Sen during the official ceremony to appoint her as a National Champion for the UN Secretary-General’s Action Plan for Women’s and Children’s Health. Phnom Penh, 21 February 2011.

The First Lady of Cambodia, Lok Chumteav Bun Rany Hun Sen, has been appointed the National Champion for the UN Secretary-General’s Action Plan for Women’s and Children’s Health at a ceremony in Phnom Penh on 21 February.

In her role as National Champion, Bun Rany will regularly visit health centres across Cambodia to advocate for healthy motherhood with midwives and other health professionals, women and their families, as well as local communities.

The UN Secretary-General launched the Action Plan in April 2010. It is a roadmap that identifies the finance and policy changes needed to improve health and save women’s and children’s lives.

Cambodia has one of the highest levels of maternal mortality in Asia, with 461 deaths per 100,000 live births. With a strong tradition of delivering babies at home, less than half of all babies are delivered in a health facility in Cambodia, and just 60% of births are assisted by trained birth attendants.

Integrated approach to the health MDGs

Although the country has a long way to go to meet its Millennium Development Goal 5 (improve maternal health) target by 2015, it has seen progress in recent years by addressing the health related MDGs through a joint and comprehensive approach. In 2007 Cambodia adopted the “Linked Response Initiative,” a national strategy to expand access to HIV, reproductive and sexual health, family planning, tuberculosis and maternal health services using the prevention of mother-to-child HIV transmission as an entry point.

Additionally, resources for the AIDS response are supporting integrated laboratory services at referral hospitals allowing tests for TB, malaria, HIV and sexually transmitted infections to be carried out in a single laboratory enabling cost and labour efficiencies and rapid return of results to patients.

“These national innovations to health delivery are leading the way to breaking down barriers to broader health care which an isolated approach to AIDS cannot achieve,” said UNAIDS Country Coordinator Tony Lisle. “It translates to a far more effective use of scarce resources and brings many more women and their children closer to meaningful and comprehensive care.”

It is hoped that Bun Rany’s role as National Champion for the UN Secretary-General’s Action Plan for Women’s and Children’s Health as well as her role as National Champion of the Asian Pacific Leadership Forum on HIV and Development will strengthen the country’s integrated approach to tackle MDGs 4, 5 and 6 and will complement the leadership of the Royal Government of Cambodia on addressing maternal and child health and HIV. Cambodia received a Millennium Development Goal Award in September 2010, an acknowledgement of the country’s efforts to halt and reverse the AIDS epidemic.

Ms Helen Evans Interim Chief Executive Officer, Global Alliance for Vaccines and Immunisation (GAVI); Dr Michel Kazatchkine Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM); Ms Tamar Manuelyan Atinc Vice President, Human Development Network, World Bank; Dr Tachi Yamada President, Global Health Program, Bill & Melinda Gates Foundation; Dr Margaret Chan Director-General, World Health Organization (WHO); UNAIDS Executive Director Michel Sidibé; Mr Anthony Lake Executive Director, United Nations Children’s Fund (UNICEF); Mr Babatunde Osotimehin Executive Director, United Nations Population Fund (UNFPA).

The Health 8 group gathered at the UNAIDS Headquarters in Geneva on Wednesday 23 February to reflect and strategize on one of most pressing issues affecting the health of the world’s population—maximizing health outcomes with available resources.

The Geneva meeting, convened in this occasion by UNAIDS Executive Director Michel Sidibé, focused on how to get “more health for the money.” Participants held discussions under three main topics: the UN Secretary-General’s Global Strategy for women’s and children’s health, the role of multilateralism in the new economic order, and the provision of technical support for capacity building.

The Health 8 (H8) is an informal group of eight health-related organizations comprising WHO, UNICEF, UNFPA, UNAIDS, GFATM, GAVI, Bill & Melinda Gates Foundation, and the World Bank. It was created in mid-2007 to stimulate a global sense of urgency for reaching the health-related Millennium Development Goals and has focused on better ways to speed up efforts to bring lifesaving-health improvements to people worldwide.

A version of this story was first published at UNODC.org

The comprehensive HIV prevention package will include access to sterile needles and syringes
Credit: UNAIDS

The Kenyan government is taking an innovative approach to reducing HIV among injecting drug users. In a bold new initiative, the government is set to give drug users free access to HIV prevention and treatment services. Supplies of sterile needles and syringes, substitution treatment, social support and referral to other health services, including antiretroviral therapy, will be available.

In a pilot project, 12 primary health care centres in Mombasa are offering drug dependence treatment and psycho-social support in several communities on an out-patient basis. For the next three months, the Kenya Red Cross will provide support to the Ministry of Health. HIV voluntary counseling and testing are also offered. The Ministry of Medical Services is preparing a rapid capacity building plan and staff will receive additional training in the next few weeks and months.

It is expected that this model will be adopted in other regions.

The action plan to roll out the comprehensive HIV prevention package follows a recent national meeting on people who inject drugs convened by the National AIDS Control Council (NACC). The meeting’s resolutions were also endorsed by Members of Parliament during a subsequent leadership workshop on HIV.

The United Nations is playing a key role in the programme and the UNAIDS family has worked in close partnership with the National AIDS Control Council and many government agencies, to encourage the adoption of this comprehensive HIV prevention package.

The United Nations Office on Drugs and Crime is also joining the government in developing an intensive training programme for 700 health professionals and civil society actors to offer quality services for injecting drug users.

Kenya’s government has recognized the importance of addressing the needs of key populations such as people who inject drugs, sex workers and their clients, men who have sex with men, and people in prisons. This was reinforced by its Modes of Transmission Study published in March 2009 which indicated that such populations accounted for more than a third of all new HIV infections. The adoption of the comprehensive package for HIV prevention among people who inject drugs is seen as a significant step forward.

Credit: The World Bank

Information about the spread of HIV in the Middle East and North Africa region has been extremely limited, with no real picture of the epidemic emerging. As a major contribution to increasing knowledge of AIDS in the region, the World Bank recently convened a discussion to highlight the first ever comprehensive scientific analysis of the epidemic.

A groundbreaking report, a joint effort involving the World Bank, UNAIDS and the World Health Organization, was the focus of the event at the Bank’s Washington Headquarters. The event on 15 February brought together policy makers from the region, politicians, researchers, civil society actors, and partners. They discussed the findings and implications for prioritizing resources amid the fundamental social and political changes currently affecting the region.

HIV in North Africa and the Middle East

HIV infection has already reached all corners of North Africa and the Middle East. There are substantial differences in the way the virus is spread across the region and various risk contexts are present. The epidemic has become generalized in Djibouti and Sudan, though prevalence in the general population in most other countries is low. The nearly one million people  who inject drugs (0.2% of the population), men who have sex with men and their sexual partners, and commercial sex networks are the most impacted by HIV. A significant number of individuals have also contracted the virus while living and working abroad.

Levels of risk behaviour, such as using non-sterile injecting equipment, are high in a number of countries in the region. This confirms the potential for further HIV spread among the key populations.

A number of social challenges, including pervasive stigma, are also facilitating the spread of the virus.

The way forward

Laith J. Abu-Raddad, the report’s main author, who participated in the World Bank discussion, believes that with today’s greater understanding of the epidemic, time is of the essence in building a more meaningful response. “We are no longer groping in the dark on HIV in the region. The data are now available and we have a good understanding of what’s happening with regard to HIV transmission and the populations affected.” He added, “The priorities are clear to address the problem of the rising epidemics in the region and it is time for policy makers and partners to take action.”

Participants at meeting agreed that the current political climate presents a window of opportunity for sustained change. They called on policy makers to focus investment on evidence-informed prevention efforts for key populations to yield long term health and social benefits.

Stigma and discrimination must also be challenged and access to testing, care, and treatment services expanded substantially.

A partnership with civil society, concerned populations and people living with HIV will be the cornerstone of effective implementation. Strengthening grassroots organizations is considered essential for cementing progress made and reaching the most stigmatized and vulnerable.

The report includes data on Afghanistan, Algeria, Bahrain, Djibouti, the Arab Republic of Egypt, the Islamic Republic of Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, the Syrian Arab Republic, Tunisia, the United Arab Emirates, West Bank and Gaza (Occupied Palestinian Territories), and the Republic of Yemen.

On Thursday, UNAIDS Executive Director Michel Sidibé (left) urged the Prime Minister of Thailand, Abhisit Vejjajiva, to lead an HIV prevention revolution in the Asia region, with the goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths. Credit: UNAIDS/V. Dithajohn

On the final day of an official country visit to Thailand, UNAIDS Executive Director Michel Sidibé praised Thailand’s Prime Minister, Abhisit Vejjajiva, for his leadership and commitment on AIDS in the country and urged Thailand to redouble efforts—and resources—on HIV prevention.

Underlining the country’s current successes, including significant advances in the provision of antiretroviral treatment and increased access to services for the prevention of mother-to-child transmission of HIV, Mr Sidibé urged Thailand to lead an HIV prevention revolution in the Asia region.

“Thailand has an outstanding record in the AIDS response which now needs to be taken to the next level,” said Mr Sidibé, encouraging Thailand to take the lead and be the first country in the region to make a concrete impact on the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. 

Thailand is known for its effective, rapid and targeted HIV response. Currently 80% of people in need have access to antiretroviral treatment and nearly 97% of pregnant women living with HIV have access to services to prevent mother-to-child transmission of HIV. The Government of Thailand funds 83% of its national HIV response, but only 14% of the national HIV budget is allocated for HIV prevention.

Prime Minister Abhisit acknowledged that HIV prevention efforts in Thailand need to be rapidly intensified and that they should be clearly focused on key affected populations, such as sex workers, men who have sex with men, and people who inject drugs. He complimented UNAIDS’ bold goal of zero new HIV infections.   Stigma and discrimination was highlighted in the meeting as one of the critical barriers in the HIV response, particularly with regard to its impact on people living with HIV and the affected communities. Prime Minister Abhisit also called attention to Thailand’s newly developed harm reduction policy and said that he was taking action to ensure the policy’s implementation across the country, starting in ten provinces.
Underlining his continued commitment to lead on the issue of AIDS, the Prime Minister expressed his interest in playing an active role in the June 2011 UN General Assembly High-Level Meeting on AIDS.

 

In his 2011 Letter to Partners, Mr Sidibé outlines a set of six new frontiers to move the global AIDS response forward: The democratization of the response; making the law work for not against AIDS; reducing the upward trajectory of programme costs; making funding for AIDS a shared responsibility; making the AIDS movement a bridge to development; and fostering scientific innovation for HIV prevention and treatment.

According to Mr Sidibé, each of the new frontiers supports the other, and he cautions that a singular advancement in any one sector alone will not be sufficient to move the entire global AIDS response forward.

This Letter to Partners coincides with the 30 years of the AIDS epidemic, the 10th anniversary of the 2001 Declaration of Commitment on HIV/AIDS and five years since the world committed to achieve universal access to HIV prevention, treatment, care and support.

“This year we have an historic opportunity to build on and improve the performance of the last three decades,” said Sidibé. “Together, we can make this the defining decade, the decade that signals the beginning of the end of AIDS,” he added in anticipation of the June 2011 General Assembly High Level Meeting on AIDS that will bring together world leaders to renew hope and re-energize the AIDS movement.

Read the 2011 Letter to Partners 

This SWING Foundation volunteer was one of many to promote messages of HIV prevention and safe sex on Valentine’s night in Bangkok. Credit: UNAIDS

High heels, sequined outfits and pumping music fill Bangkok’s ‘Soi Cowboy’ street. For many, it’s a typical evening in one of the city’s well-known red-light zones. But a closer look at the fashion parade tells that this isn’t just any other night—the elaborately designed outfits, made entirely from condoms, are part of a Valentine’s night HIV prevention drive led by SWING (Service Workers In Group) Foundation, a Thai-based non-governmental organization.

With HIV prevention-slogan banners raised high in the air—“Safe sex, safe life!”, “Heart of love, heart of condom!”— volunteers from SWING walk the temporary runway, handing out condoms and information leaflets. Such targeted HIV prevention drives are just one aspect of SWING’s work with men, women and transgendered “service workers,” SWING’s preferred terminology for sex worker.

Based in the Thai red light districts of Bangkok, Pattaya and Ko Samui, the SWING Foundation provides educational opportunities for workers, including English language classes and vocational training. The Foundation also serves as a drop-in centre where workers can stop by, eat, use the internet, prepare for the evening, and take part in HIV-related information games and sessions.

“Our activities help workers increase their self confidence and possibilities to develop their individual potential,” said Surang Janyam, who co-founded SWING in 2004. “For many, it is so hard to feel they can get support, and they fear discrimination. SWING provides a safe space and options,” she added.

An established success story in Thailand, SWING’s reputation is spreading across borders as a model for programmes that provide HIV services where they are most needed. Its success is ascribed in part to the fact that Foundation is managed and run almost entirely by current or former sex workers.

Across the Asia-Pacific region, an increase in the size and scale of programmes focused on populations at higher risk of HIV exposure—planned and implemented by the communities themselves—is urgently needed.

According to the latest available data, most epidemics in the region are still concentrated among people who inject drugs, sex workers and men who have sex with men. In a number of countries, there are signs of increased HIV infection rates among these key affected populations. Data, where available, on HIV prevention coverage from a number of countries across the region suggest that less than half—and in some cases only one third—of people from key affected populations have been reached by prevention services.

“In the Asia-Pacific region, we know that HIV responses must focus solidly on key affected populations if we are to sustain and advance progress,” said UNAIDS Executive Director Michel Sidibé, who was a special guest at the Valentine’s event hosted by SWING. “We need to drive commitment and action to ensure programmes like SWING are emulated and multiplied across the region,” he added.

In Soi Cowboy on Valentine’s night, the message is loud and clear: Nothing about us without us. “We care about you!” shouted SWING co-founder Khun Tee through a megaphone, as his colleagues paraded by in their colourful condom combinations. “HIV is real—please use a condom every time you have sex with anyone!”