First Lady of Rwanda greeting Proffesor Tlou, UNAIDS ESA Director, together with Dr Sezibera, Minister of Health. Credit: UNAIDS

Rwanda’s National Accelerated Plan for Women, Girls, Gender Equality and HIV 2010-2014 was unveiled on 10 November at an event at the Parliament, in the capital Kigali.

The event was presided over by the First lady of Rwanda, Ms Jeannette Kagame, along with the Speaker of the Rwandan Parliament, Ms Rose Mukantabana, the Minister of Health, Dr Richard Sezibera, and the Executive Secretary of the National AIDS Control Commission, Dr Anita Asiimwe, in front of members of both chambers of the Rwandan Parliament.

The broad range of representatives present at the launch echoed the diverse stakeholders involved in the plan’s development, including national institutions, development partners, civil society organizations, and the private sector.

The First lady commended the commitment of the Ministry of Health, the National AIDS Control Commission, development partners, and civil society organizations in responding to HIV through an evidence-informed approach.

Some 3% of the adult population in Rwanda is living with HIV and in urban areas HIV prevalence as high as 7.3%. HIV prevalence in women is 3.6%, which is significantly higher than in men, at 2.3%.

“Rwanda can not stop the spread of HIV without addressing women and girls and highlighted the importance of ensuring equitable allocation of resources, women’s participation in decision-making, and engagement of men and boys to address harmful gender norms,” said the First Lady.   

Young women are far more often infected by HIV than young men, and in urban areas HIV prevalence is 3.9% among young women versus 1.1% among young men.

In her opening remarks, the Speaker of the Parliament noted, “I am convinced that great efforts have been made in our country to stop the spread of HIV and to take care of those infected or affected. However, there is still a long way to go to achieve the objective of an AIDS-free generation.”

In addressing those gathered, the Director of the UNAIDS Regional Support Team for Eastern and Southern, Professor Sheila Tlou, also commended the leadership and evidence-informed planning shown by the Government of Rwanda in its HIV response.  

Rwanda has been selected by UNAIDS as a champion country globally, to share lessons with and inspire the work of other countries on the agenda for accelerated country action.

Professor Tlou recognized the ambitious goals of Rwanda’s National Strategic Plan on HIV and AIDS 2009–2012 of reaching 60% of sex workers with prevention programs, increasing condom use to 93%, and raising comprehensive knowledge of HIV to 70% by 2012.

“We also recognize, without question, that focusing on reducing infections among women and girls, does not mean not working with men and boys,” said Professor Tlou.

According to the recent Behavior Surveillance Survey (2010), HIV prevalence among sex workers in Kigali city is 59%, rising to over 90% among people aged 35 and over. In relation to this, the Minister of Health, Dr Richard Sezibera, highlighted the fact that the response to HIV is not an academic exercise; it is “a fight that brings benefit to individuals in our country.”

A longer version of this article appeared in the November Bulletin of the World Health Organization   

Credit: UNAIDS

When she was four years old, Thando* was taken to a public hospital in Johannesburg for HIV treatment. “I first saw her in 1998 with advanced disease and her CD4 count was less than 50,” says Ashraf Coovadia, a paediatrician at the Rahima Moosa Mother and Child Hospital. “In 1999 we managed to get her antiretrovirals (ARVs) through a research project.”

Prior to 2003, ARVs were not available in the public health system in South Africa, the country with the highest number of people with HIV in the world. While private patients could get access to the life-saving drugs and buy their survival, many patients in the public sector did not survive.

It is this stark public–private divide that the South African government hopes its proposed National Health Insurance (NHI) scheme will tackle by providing universal access to health care “based on need rather than ability to pay.”

Thando was lucky to get therapy in time and this “lovely teenager”, raised by her aunt, is the longest attending patient at the hospital’s paediatric clinic. “Prior to the rollout, we had a handful of children accessing ARVs, less than 5%. Now the majority who need it are on ARVs and doing well,” says Prof Coovadia.

Access to treatment for HIV has expanded dramatically in the past decade and, since the 1994 democratic elections, access to health services in general have improved for poorer South Africans. However, some believe that the standard of care in the public sector has been steadily deteriorating.

“South Africa has had difficulty post 1994 in grappling with the HIV epidemic—that was a real curveball,” says Helen Schneider, Chief Researcher at the University of Cape Town’s (UCT) Centre for Infectious Diseases Epidemiology and Research.

Health Minister Aaron Motsoaledi told the Bulletin: “the starting point for the NHI is to close the increasing gap between the rich and the poor. If I am sick, I get the best care. If people are unemployed, they can forget it.” Dr Motsoaledi describes the existing health-care system as “very expensive, destructive, unaffordable and not sustainable.”

In September 2010, the ruling African National Congress (ANC) released its current proposals for the NHI for wide consultation. According to Zweli Mkhize, chairman of the ANC’s health committee, the scheme, which aims to provide universal coverage for all South Africans, is expected to cost an extra R11 billion on top of the R117 billion in the government’s health budget for 2012. Taxation to pay for this compulsory medical insurance scheme is expected to start in 2012, with a plan to phase it in over 14 years.

A private economic consultancy, Econex, has published an extensive critique of the proposals, teasing out some of the implementation challenges, chief among them the enormous anticipated cost of the system as currently conceptualized.

And cost models produced for the Congress of South African Trade Unions, which strongly supports the introduction of NHI, suggest an additional funding requirement of around R189 billion, before administrative savings.

The NHI would also introduce new dimensions to the South African health financing system, notably the possibility of using public resources through strategic purchasing of services for the population. According to Di McIntyre, a professor from UCT’s Health Economics Unit, this would ensure that “everyone will be able to access health services on the basis of their need for care and not on the basis of their ability to pay.”

*Thando’s name has been changed.

This is the third of five animated films for the social media initiative “HIV #PreventionRevolution”, that UNAIDS is running in the lead up to World AIDS Day 2010.

The aim is to inspire and encourage people using social media to know more about HIV prevention. The collective goal is to make the hashtag #PreventionRevolution shared as much as possible on 1 December 2010.

For the past two weeks, conversations have focused on why an HIV prevention revolution is needed and condom programming, under key messages such as “80% of HIV transmission is sexual” and “More than 7 000 people are infected with HIV everyday”.

It has connected tweeters such as @UN, @MTVStayingAlive, @Oxfam and @AnnieLennox. 

Most importantly the conversation has engaged twitter users from all walks of life; all tweeting about the Prevention Revolution at the same time across at least five continents!

People on twitter have shared personal stories, called out for action on local level and the tweets seem to be sharing information that users did not previously have. For example:

@LoganLevkoff, tweeted: “Unacceptable,” in reply to the fact that only 1 in 3 young people have knowledge of how HIV is transmitted.

@0newinfections, a person on twitter living with HIV who uses twitter, urged his followers to join the conversation:  

“I often wonder how long will i live. I became HIV positive when i was 25. Maybe 10 years more or 20? Be a part of the #PreventionRevolution”

Users have also come up with a new word on twitter “Edutweeting,” made from Education and Tweeting for what the initiative is trying to achieve.

This week’s discussion starter is the animated film Light, embedded above. Follow the conversation on twitter here and by visiting UNAIDS on Facebook.

Michael Ballack, the captain of the German national football team and UNAIDS Goodwill Ambassador, has been awarded the famous German prize “sportler mit Herz,” or ”athlete with heart”, for his committed and outstanding work with UNAIDS.

The award was presented on 6 November 2010 before an audience of almost 3000 which included personalities from the world of sport, art and entertainment as well as national politicians.

At the reception, Mr Ballack said he was honored by the award, and accepted it on behalf of his UNAIDS colleagues.

“UNAIDS has a vision of Zero new infections, Zero discrimination and Zero AIDS-related deaths. This is a vision that I share and I am proud to be doing my part to help,” Mr Ballack noted.

A UNAIDS Goodwill Ambassador since 2006, Mr Ballack along with fellow international soccer player Emmanuel Adebayor, focuses on raising awareness about HIV prevention among young people. As a role model for young men around the world, he has participated in a number of campaigns to raise awareness on how to prevent HIV.

A version of this story first appeared at undp.org

Most developing countries made dramatic yet often underestimated progress in health, education and basic living standards in recent decades, with many of the least developed countries posting the greatest gains. This is one of the key findings revealed in the United Nations Development Programme (UNDP) 2010 Human Development Report, released 4 November.

However, despite significant progress in some countries, patterns of achievement vary greatly, with some nations losing ground since 1970, the report shows. The 20th anniversary edition, which introduces three new indices for inequality, gender and poverty, documents wide inequalities within and among countries and deep disparities between women and men on a broad range of development indicators. It highlights the prevalence of extreme multidimensional poverty in South Asia and sub-Saharan Africa and the AIDS epidemic is also shown to have had a marked negative impact on progress in some countries.  

The report, called The Real Wealth of Nations: Pathways to Human Development, was launched by UN Secretary-General Ban Ki-moon, UNDP Administrator Helen Clark and Nobel laureate Amartya Sen who helped devise the HDI for the first Human Development Report in 1990 with the late economist Mahbub ul Haq, the series founder.

“The Human Development Reports have changed the way we see the world,” Ban Ki-moon said. “We have learned that while economic growth is very important, what ultimately matters is using national income to give all people a chance at a longer, healthier and more productive life.”

According to Helen Clark, “The report shows that people today are healthier, wealthier and better educated than before. While not all trends are positive, there is much that countries can do to improve people’s lives, even in adverse conditions. This requires courageous local leadership as well as the continuing commitment of the international community.”

Overall, as shown in the report’s analysis of all countries for which complete HDI data are available for the past 40 decades, life expectancy climbed from 59 years in 1970 to 70 in 2010, school enrolment rose from just 55 percent to 70 percent, and per capita GDP doubled to more than US$ 10,000. Several poorer countries have registered substantial gains in education and public health, including Benin, Cambodia and Ethiopia, which ranked  11^th in progress over time.

The region with the fastest HDI progress since 1970 was East Asia, led by China and Indonesia. A number of countries in sub-Saharan Africa and the former Soviet Union lagged behind, however.

“We see great advances, but changes over the past few decades have by no means been wholly positive,” the authors write. “Some countries have suffered serious setbacks, particularly in health, sometimes erasing in a few years the gains accumulated over several decades... And the gaps in human development across the world, while narrowing, remain huge.”

African Women Championship 2010, group A match: South Africa vs Tanzania, 31 October 2010 Credit: CAF

Captains of all eight national teams competing in the 2010 African Women’s Football Championship in South Africa have joined forces to support the Give AIDS the Red Card campaign to end mother-to-child transmission of HIV.

The campaign was initiated during the 2010 FIFA World Cup by UNAIDS Executive Director Michel Sidibé and Kirsten Nematandani, President of the South African Football Association (SAFA). It reinforces global efforts to virtually eliminate mother-to-child transmission of HIV by 2015.

At the opening ceremony of the Women’s Championship on 31 October at Sinaba Stadium in Benoni, South Africa, the captains of the qualifying teams from Algeria, Cameroon, Ghana, Mali, Nigeria, Tanzania and South Africa, publicly read the appeal:

“As captains and players of teams competing in the 2010 African Women’s Championship in South Africa, we appeal to football players and fans across Africa to celebrate life and help prevent mothers from dying and babies from becoming infected with HIV…together we must Give AIDS the Red Card to prevent mothers from dying and babies from becoming infected with HIV.”

Each year, an estimated 430 000 babies worldwide are born with HIV a large majority in Africa. In many parts of Africa, AIDS-related illness is the leading cause of death among infants and young children. HIV is also the leading cause of death and disease among women of reproductive age worldwide.

Mr Nematandani explained why SAFA is supporting the campaign during this tournament. “Football represents one of the biggest voices in the world and SAFA, as the custodian of football in South Africa, has decided that it will join its voice to the many voices making a difference in the response to HIV around the world.” He concluded, “There is no better way to show this than to articulate it repeatedly during these important championship matches.”

The team captains also committed to read out the appeal at the start of each of the 14 matches that will play in  the championship which runs until 14 November 2010.   

ICPA Executive Director, Mr. Ed Wozniak presenting the award to Dr Fabienne Hariga, Senior Expert, HIV/AIDS Section at UNODC who accepted the award on behalf of the network.

The African HIV in Prisons Partnership Network (AHPPN) has been presented with the prestigious 2010 Healthcare Award by the International Corrections and Prisons Association (ICPA).The award was given during the Association's Annual Conference which took place in Ghent, Belgium from 24 - 29 October.

The Executive Director of ICPA, Mr Ed Wozniak, noted that the award was given in light of the “remarkable and innovative work in the area of HIV of the African HIV in Prisons Partnership Network (AHPPN)”.   

The AHPPN is an initiative of the United Nations Office on Drugs and Crime (UNODC). It was created to support governments in their efforts to mount an effective, human rights-based response to HIV and TB in prisons in Africa, and to offer a platform for national, international and multi-sectoral cooperation and action.

According to a 2007 UNODC report existing data suggest high HIV prevalence rates among African prisoners as compared to the general adult population. A study cited in the report indicated HIV prevalence as high as 40% among prisoners in some prisons in South Africa. (The study was conducted in a limited number of prisons and not considered representative of the entire prison population in South Africa.).

Formally launched in November 2009 by UNODC, in partnership with the World Health Organization, the World Bank and UNAIDS, the work of the AHPPN is guided by the belief that ‘good prison health is good public health’.

The network’s efforts include a new website, and has built a comprehensive data collection questionnaire to gather up-to-date and reliable primary source data on HIV in prison settings.

Accepting the ICPA Healthcare Award on behalf of the AHPPN was Dr Fabienne Hariga, Senior Expert, HIV/AIDS Section at UNODC and AHPPN Steering Committee member and Zambian Commissioner of Prisons, Mr Percy Chato.

Former UN Secretary-General Kofi Annan (left), UNAIDS Executive Director Michel Sidibé (centre) and Hon Sarah Wescot-Williams, Prime Minister of St Maarten. Credit: UNAIDS

At the 10th annual general meeting of the Pan-Caribbean Partnership Against HIV and AIDS (PANCAP), held in St Maarten, Netherlands Antilles, UNAIDS Executive Director Michel Sidibé joined former UN Secretary-General Kofi Annan and Caribbean leaders to take stock of progress, challenges and lessons learned in the regional response to the HIV epidemic over the past decade.

In his remarks at the opening of the meeting, Mr Sidibé congratulated leaders across the region for keeping HIV high on the development agenda and highlighted the critical role that PANCAP can play in accelerating the HIV response. “PANCAP is the tool for helping us make the call for social justice in the Caribbean,” he said.
According to a new UNAIDS report, The Status of the HIV epidemic in the Caribbean, there were between 210 000 and 270 000 people living with HIV in the Caribbean in 2008. Haiti and the Dominican Republic account for about 70% of all people living with HIV in the region. In the English-speaking Caribbean, Jamaica is the country most affected by the epidemic, with an estimated 27 000 people living with HIV.

The report cites a number of achievements in the regional HIV response. More than 90% of pregnant women in 11 Caribbean countries are now tested for HIV every year. About 52% of pregnant women receive services for the prevention of mother-to-child transmission of HIV, which led to an 18% reduction in new HIV infections among children in 2008.
Governments across the region provided antiretroviral treatment to 51% of people in need in 2008—up from just 1% in 2004.  Greater access to antiretroviral treatment is saving lives: since 2001, AIDS-related deaths have dropped by about 40% in the region.

Criminalization of homosexuality

Two-thirds of countries in the Caribbean continue to criminalize homosexuality. Where homophobia is institutionalized in the law, stigma and discrimination against men who have sex with men is pronounced. Homophobia blocks access to HIV prevention programmes and impacts the quality of care for people living with HIV.

“Imagine yourself as a gay man in such an environment. How confident would you feel about getting an HIV test, or asking for information on prevention or treatment?” asked Mr Sidibé. “Homophobia hurts wherever it haunts—from classrooms to courtrooms,” he added.

HIV prevention not reaching key populations

Among men who have sex with men, HIV prevalence varies from an estimated 6.1% in the Dominican Republic to 32% in Jamaica. HIV prevalence among female sex workers—another key affected population in the region—varies from 2.7% in the Dominican Republic to 27% in Guyana.
According to the UNAIDS report, HIV prevention programmes reach less than 40% of men who have sex with men and less than 50% of female sex workers in the region. Meeting participants agreed that expanding HIV services for those most vulnerable to infection would be critical to an effective regional HIV response.

Lebo M with UNAIDS Executive Director Mr Michel Sidibe. Geneva. 28 October, 2010. Credit: UNAIDS

UNAIDS International Goodwill Ambassador South African Lebo M, visited the UNAIDS Secretariat headquarters in Geneva last week to participate in a consultation on how to leverage sports and culture for AIDS advocacy. He shared advice from his perspective as a successful producer of global shows including The Lion King and the FIFA 2010 World Cup opening ceremony.

During his stay he also participated in a series of technical briefings on UNAIDS strategy on prevention of mother-to-child transmission of HIV which is an issue that is close to his heart and that he invests time in advocating for. Lebo also had an opportunity to hear about stigma and discrimination and travel restrictions for people living with HIV and was updated on progress towards universal access to HIV prevention, treatment and care and support services.

Lebo met with UNAIDS Executive Director Mr Michel Sidibe and UNAIDS Deputy Executive Directors Dr Paul De Lay and Ms Jan Beagle who expressed their support and encouragement in his advocacy role in the AIDS response as Goodwill Ambassador.

Secretary-General Ban and Viet Nam Deputy Prime Minister H.E. Truong Vinh Trong talking to people living with HIV on Methadone for drug dependence and antiretroviral treatment at Tu Liem health care centre. 29 October 2010. Credit: UN Viet Nam/Doan Bao Chau

United Nations Secretary-General Ban Ki-moon visited a “one-stop shop” health centre for HIV services in Hanoi, Viet Nam on 29 October together with H.E. Mr Truong Vinh Trong, Deputy Prime Minster and chairman of the National Committee on AIDS, H.E. Nguyen Quoc Trieu, Minster of Health, H.E. Nguyen Thi Kim Ngan, Minister of Labour – Invalids and Social Affairs, and H.E. Le The Tiem Vice Minister of Public Security and delegates of the United Nations Country Team.

The HIV epidemic in Viet Nam is concentrated among key populations at higher risk. While HIV prevalence among adults aged 15-49 is estimated at 0.44%, prevalence is significantly higher among men who have sex with men, people who inject drugs and sex workers in the country.  For example, HIV prevalence among people who inject drug is about 30%, and in some provinces nearing 50%.
Viet Nam’s HIV response has benefited from the increase in political commitment in recent years. During the visit to the Health Centre, the Deputy Prime Minister, H.E. Truong Vinh Trong highlighted that “Viet Nam is considering turning the national response to HIV into a National Target Programme. This will help ensure the sustainability of the response to HIV and the achievement of the Millennium Development Goal on HIV.”

The Tu Liem District Health Centre in Hanoi provides HIV-related services, including HIV counselling and testing, and peer education to key populations at higher risk. The centre also distributes condoms, clean needle and syringes. Recently a government programme was started to provide methadone maintenance therapy, as part of a role out of methadone clinics across the country.

“This health centre is not only preventing the further spread of HIV. You are not just reducing deaths from AIDS in Viet Nam. You are achieving much more,” said Secretary-General Ban to the staff working at the Tu Liem District Health Centre. “You are giving life to people who will contribute to the development and success of Viet Nam.”

Secretary-General Ban also spoke to people living with HIV who were receiving methadone for drug dependence treatment as well as antiretroviral treatment. Many at the centre told the Secretary-General how methadone has changed their lives.

Secretary-General Ban thanked the participants for speaking out on behalf of people living with HIV and he also stressed the importance of addressing issues such as stigma and discrimination to enable people to access HIV services with dignity.

“Viet Nam has significantly scaled up its response to HIV in recent years and has experienced significant progress. I urge the international community to stand by the commitments made to this country to ensure a sustained response to the epidemic and not withdraw their funding,” concluded Mr Murphy, UNAIDS Country Director, speaking on behalf on the UN Country Team.