A version of this story has been published at unicef.org 

Credit: UNICEF/NYHQ2010-1057/Susan Markisz

UNICEF Executive Director Anthony Lake joined the Government of Kenya and other partners on 29 October to role out an innovative approach to prevent the transmission of HIV from mothers to their babies (PMTCT). The initiative includes a combination of activities and supplies including a “Mother-Baby-Pack” of antiretroviral drugs and antibiotics, which women can easily administer at home.

The “Mother-Baby-Pack” is part of the government’s Maisha mother-to-child transmission free Zone Initiative. This pioneering programme is designed to help virtually eliminate mother-to-child-transmission of HIV and paediatric AIDS by 2013 in Nyanza and Rift Valley provinces, where about half of all Kenyan children with HIV live, and by 2015 in the entire country. Without treatment, around half of all babies born with HIV will die before their second birthday
Mr Lake commended the Kenyan government for its commitment to take ground-breaking steps to expand and strengthen the quality of PMTCT services. “Maisha means ‘Life’ in Kiswahili, and I can think of no better way to describe a programme with the potential to save so many lives,” he said. “The Maisha Initiative is a significant step forward towards our common goal of virtually eliminating mother to child transmission in Kenya.”

The roll-out in Kenya of the “Mother-Baby-Pack” marks the beginning of a phased implementation in four countries, including Cameroon, Lesotho and Zambia. It is scheduled to run until mid-2011. During this initial phase, UNICEF and its partners will closely monitor the acceptance of the pack by women, as well as the quality of supply and distribution.

The packs were developed by UNICEF in collaboration with the World Health Organization (WHO), UNITAID, and other partners. Health workers in antenatal clinics will distribute them to pregnant women living with HIV, but who do not yet need antiretroviral treatment for their own health.  The initiative is designed to reach pregnant women who have tested positive for HIV, but who might not otherwise return to a clinic following their diagnosis.

Mother-Baby Packs arrive in Nairobi. They are then loaded onto a UNICEF truck for distribution to other parts of Kenya. Credit: UNICEF Kenya/2010/Joseph Munga

The initiative is supported financially by a number of partners including the US Government, UNICEF National Committees, the Clinton Health Access Initiative (CHAI) and the Mothers-to-Mothers (M2M) programme.

While adult HIV prevalence in Kenya has declined steadily, there are still some 22,000 new infections annually among infants through mother-to-child transmission. Overall, an estimated 1.4 million people are living with HIV in the country, including around 81,000 pregnant women.

UN Secretary-General Ban Ki-moon hands a methadone dose to a patient at Cambodia's first methadone clinic in Phnom Penh, October 28, 2010

Nearly 10% of global HIV infections are due to unsafe injecting drug use. Sharing contaminated needles and injection equipment can readily transmit HIV. Of the estimated 15.9 million people who inject drugs, 3 million are infected with HIV.

In a recent visit to the first methadone clinic in Cambodia, United Nations Secretary General Ban Ki-moon praised government authorities and health workers for their efforts to reduce HIV infection and drug-related harm among injecting drug users. Launched in July 2010, the clinic has reached, to date, a total of 61 patients.

“This methadone maintenance therapy programme is providing an important service, not just to people struggling to conquer addiction, but to the broader community,” said Secretary-General Ban, after touring the clinic at the Khmer Soviet Friendship Hospital. “Evidence shows that such initiatives are more effective than incarceration in addressing the social problems caused by addiction.”

Opioid substitution therapy with methadone or buprenorphine is one a number of proven evidence-based measures that reduce HIV infection and drug-related harm, including access to sterile injecting equipment, HIV testing and counselling, antiretroviral therapy, condom promotion to drug users and their sexual partners and community-based outreach.

While countries are increasingly adopting such harm reduction measures, coverage remains poor. According to the UN Reference Group on HIV and injecting drug, only 8% of injecting drug users globally receive opioid substitution therapy and just 4% of HIV-positive injecting drug users receive antiretroviral therapy. Only two needle syringes per injecting drug user are distributed per month.

Experience has shown that law enforcement approaches alone do little to reduce drug use and drug-related crime. Laws criminalizing the possession of injecting equipment or substitution therapy are major barriers in the HIV response, as the fear of criminal measures and prosecution force many drug users underground and lose the opportunity to stabilize their lives.

A Forced Migration Review special supplement

Kibati camp for displaced people, DRC. Credit: Christian Als

The interconnections between conflict and HIV are complex. HIV affects the lives of many people caught up in conflict, including the civilian population but also the protagonists, as well as those whose role it is to provide security during and after conflict.

In conflict, people may be subjected to mass displacement and human rights abuses, including sexual violence, or left in conditions of poverty and powerlessness that might force some individuals to sell sex to survive. In addition, infrastructure may be damaged, and prevention and health services disrupted. Such conditions put populations at increased risk of HIV infection, and women and children are especially vulnerable.

A special supplement on HIV has been published by the journal Forced Migration Review, with support from UNAIDS. This edition is largely based on the work of the AIDS, Security and Conflict Initiative (ASCI), which undertook research over a number of years to gather evidence and advance analysis on the connections between HIV and conflict.

Specially tailored programmes to ensure universal access to vulnerable groups must become an integral part of national HIV policies and strategies, and a key item on the agenda of the international community, according to the article by UNAIDS.

The analysis addresses how to achieve greater and better access to HIV prevention, treatment, care and support for people during and after conflict. It concludes that it is unlikely that Millennium Development Goal 6 will be met without HIV services reaching displaced populations and migrants, regardless of their HIV status, as well as the uniformed services that interact with these populations.

The supplement presents a selection of the ASCI case-studies alongside a number of articles on the subject which were submitted in response to a Forced Migration Review call for articles. UNAIDS and its cosponsors UNFPA and UNHCR as well as various research partners contributed articles. In addition, Dr Nafis Sadik, Special Envoy of the UN Secretary General for HIV/AIDS in Asia and the Pacific authored a piece on the linkages between forced migration and HIV in Asia.

Download the full publication here

Mr Festus Mogae, former President of Botswana (centre); Professor Miriam Were, former Chairperson of the Kenya National AIDS Control Council (left); and Hon A. K. Mwanamwambwa, Speaker of Zambian National Assembly (right). Credit: UN/Sirak Gebrehiwot

In a recent mission to Zambia the Champions for an HIV-Free Generation, an organization of African leaders which includes former presidents and other influential personalities, met with top government officials to help push Zambia’s AIDS response forward. Zambian President Rupiah Banda unveiled a new National AIDS Strategy in the presence of the Champions that aims to increase access to antiretroviral treatment and reduce HIV infections in Zambia by 50% by the year 2015.

Zambia has one of the highest HIV prevalence rates in the world. According to the latest UNAIDS estimates, 15.2% of the adult population is living with HIV and more than 80,000 adults are newly infected with HIV annually. For every two people who start antiretroviral therapy, an estimated five more become newly infected with the virus.

Led by Mr Festus G. Mogae, former president of Botswana, the delegation of Champions met with government authorities, traditional leaders, civil society representatives, people living with HIV and development partners. Mr Mogae inspired local leaders to strive for virtual elimination of mother-to-child transmission of HIV through the example of Botswana, where rates of infants born to HIV-positive mothers have been reduced from 20% in 2003 to below 4% in 2007.

While in Zambia, the Champions underscored the importance of preventing new HIV infections through proven interventions, including male circumcision and correct and consistent condom use. Gender-based violence and the heavy burden placed on women by HIV were also addressed head on. 

“Culture is important, but if your culture or traditions are killing you, you must think about change,” said Professor Miriam Were, a member of the Champions delegation and former Chairperson of Kenya’s National AIDS Control Council.

The Champions held frank discussions on the financial sustainability of the HIV response in the region and the need to move quickly to be effective. “A stick that is far away cannot kill a snake, and if you tap it on the tail and wait for your neighbour to hit it on the head, you will find yourself in trouble,” said Champions delegate Dr. Speciosa Wandira, former Vice-President of Uganda.

Credit: UNAIDS

Sport has a special ability to unify and galvanize people all over the world and therefore is a powerful vehicle for advocacy at the global down to the community level. In light of the potential of sports for AIDS advocacy, UNAIDS organized a consultation with representatives of several sports organizations and other experts from 24-26 October in Geneva to examine current initiatives and ideas for future activities.

“Sport has tremendous worldwide influence and impact, from the highest level of world championship events to children in remote villages playing with a home-made football,” said UNAIDS Executive Director at the opening of the consultation. “Stronger cooperation with the world of sport can invigorate the global AIDS response in a unique way and help us achieve all the Millennium Development Goals,” he added.

The consultation identified new ways to leverage the convening power of sports to promote HIV prevention, treatment, care and support. Participants also reviewed existing relationships and ways to build and strengthen partnerships between UNAIDS at the global, regional and country-levels, and the world of sports, the private sector, civil society and the media.

UNAIDS has established partnerships with sports personalities and organizations to raise awareness on AIDS issues and to help inform people on how to protect themselves against HIV infection. The 2010 FIFA World Cup initiative “Give AIDS the Red Card”, was backed by international football stars including UNAIDS Goodwill Ambassadors Michael Ballack of Germany and Emmanuel Adebayor of Togo. The campaign used the popularity and the outreach potential of football to unite the world around a common cause—preventing the transmission of HIV from mother-to-child.

This week’s consultation provided a forum to review progress around the “Give AIDS the Red Card” campaign and plan for the next phase. It also enabled discussions on future sports initiatives with UNAIDS’ partners including the International Olympic Committee and the International Cricket Council as well as identifying other cooperation opportunities with sports organizations and sports stars and stronger coordination with Cosponsors.

Participants agreed to explore innovative ways to convey HIV messaging through sports. Because the world of music and culture also has great popular appeal, the meeting also considered linkages with sport-related initiatives to amplify the range of the messages.

Other participants included Mr Adolf Ogi, former President of Switzerland and former Special Advisor to the UN Secretary-General on Sport for Development and Peace; Mr Wilfried Lemke, Special Adviser to the UN Secretary-General on Sport for Development and Peace; Mr Krisrten Nematandani, President, South African Football Association; Mr Lebohang Morake (Lebo M), UNAIDS Goodwill Ambassador and producer of the 2010 FIFA World Cup opening ceremony; Ms Katia Mascagni, International Olympic Committee; Mr Chris Hurst, Corporate Communications Manager, International Cricket Council;  Mr Amadou Fall, Vice President for Development in Africa of the NBA; Mr Adonal Foyle, Retired NBA basketball player and founder of the Kerosene Lamp Foundation; and, Mr Driss Guerraoui, Adviser to the Prime Minister of Morocco and Convener of the Global Youth Forum.

“More than 7000 people are infected with HIV every day. We need a prevention revolution.” This is the message that UNAIDS is using today to launch a social media initiative across twitter and facebook to revitalize interest in HIV Prevention in the lead up to World AIDS Day 2010.

Starting 26 October, for six consecutive Tuesdays, UNAIDS will introduce a series of themes related to HIV prevention via discussions on facebook and Twitter and through YouTube clips, interactive polls and quizzes. As part of the initiative, five animated films have been developed as conversation starters.

The aim is to inspire and encourage people using social media to know more about HIV prevention, as well as to make the keyword (or hashtag as it is known on Twitter) #PreventionRevolution trend on Twitter in as many places as possible on 1 December 2010. 

The social media project will reinforce the work of the recently launched High Level Commission of HIV Prevention, whose stated aim is to bring about a prevention revolution. Many of the commissionaires are already using social media to raise awareness about HIV prevention. 

“HIV spreads through networks, but networks are also the best defense when people are informed and empowered to protect themselves,” said Michael Bartos Chief of Prevention, Risk and Social Vulnerability with UNAIDS. “Using social media is a natural progression for UNAIDS’ goal of raising awareness and bring about progressive social change.”

The concept was developed in dialogue with the MTV Staying Alive campaign, which is also supporting the initiative.    

Find out more, visit UNAIDS on facebook: http://on.fb.me/95aBoI

Where the twibbon: http://twb.ly/bQSXBj

UN Secretary-General Ban Ki-Moon speaking at the "Light for Rights" event during the World AIDS Day celebrations in New York City in 2009.

The first Light for Rights: Keep the light on HIV and human rights event was held on 1 December 2009 in New York. The United Nations Secretary-General Ban Ki-moon joined leaders in the AIDS response and entertainment stars to commemorate World AIDS at the City’s historic Washington Square Park Memorial Arch.

Lights on the arch and other landmarks around the city were turned off to remember family and friends lost to AIDS, and to represent how stigma, discrimination, fear and shame can drive people living with HIV into darkness. Then, the lights were re-lit to show how shining a human rights light on HIV can help people living with HIV emerge from the shadows, to seek the information, treatment, care and support.

Light for Rights was inspired by Night without Light, a project organized by Visual AIDS in the early 1990s in which the skylines of New York and San Francisco were darkened, by turning off the architectural illumination on key landmarks, as a symbolic reflection for the lives lost due to HIV.

The Light for Rights campaign compliments the theme for this year’s World AIDS Day: human rights and universal access. The year, it encourages 100 cities around the world to dim the lights on public landmarks to remember the devastating affect AIDS has had, and to turn the lights back on to illuminate the fundamental human rights shared by all but often denied people living with HIV.

“The Light for Rights campaign sends a message of hope to the world,” said Michel Sidibé, Executive Director of UNAIDS. “The power of light can convey the message that human rights are essential to the AIDS response.”

The Lights for Rights initiative is organized by a coalition comprised of  The World AIDS Day campaign, UNAIDS, amfAR, and Broadway cares/Equality Fights AIDS. To find out more about how to organize a Lights for Rights event in your community or city this World AIDS Day visit the Light for Rights web site (www.lightforrights.org).

UNAIDS speaks with organizations in North America and Europe to better understand patterns of human rights violations and the connections to health

Caption Credit: UNAIDS

The recent suicides among gay teens in the United States of America (USA) after bullying and cruel treatment because of their perceived sexual orientation highlights the fact that homophobia continues to exist in all societies. Despite acceptance in popular culture in many countries, young lesbian, gay, bisexual and transgender people (LGBT) can face some of the same barriers presented by stigma and discrimination as previous generations.

“Violence against members of the LGBT community is unacceptable, no matter where in the world it occurs,” Michel Sidibé said UNAIDS Executive Director. “Governments must fulfill the rights of all people, regardless of sexual orientation and gender identity.”

A public opinion poll conducted in the USA in May this year found that while more than half of Americans believed that gay and lesbian relationships were acceptable, 43% still feel that such relationships are morally unacceptable. 

“Clearly homophobia remains a serious problem in the United States, but I think we’re heading in the right direction—just not quickly enough,” says Chris Collins, Vice President and Director of Public Policy for the American Foundation for AIDS Research (amfAR).

In the wake of recent anti gay-violence, a USA faith alliance called on the Universal Church to work to “end the violence and hatred against out lesbian, gay, bisexual, and transgender brothers and sisters.”

Institutional homophobia is easier to pin-point as discriminatory, such as punitive laws criminalizing same sex behaviour. However negative attitudes towards members of the LGBT community can exist even when protective laws are in place, and these are more difficult to address.

University student Emily Carson, a member of the Global Youth Coalition of HIV/AIDS, is from Connecticut, a state which has protective laws. Growing up in a small conservative town Ms Carson said she was harassed and bullied for years, because she was perceived as different. When first hearing about the suicides among gay teens in the US, Ms Carson said she was heartbroken. She had hoped schools had gotten better.

But Ms Carson also has a different worry: “Every few years this happens (gay kids committing suicide or the political cycle of the gay marriage debate), and people start talking about anti-homophobia. I worry that this public outcry is going to die down until the next time something happens,” she said. “We need to pay attention to this on a daily basis, not only when there is a tragedy involved.”

Social change requires more than legal reform, and the situation is similar in Europe. German-born Alex Müller, a board member of the International Lesbian, Gay, Bisexual, Transgender and Queer Youth and Student Organization (IGLYO), agrees: “On the one side there is legislative progress in Europe, but at the same time homophobic perceptions prevail in all parts of society.”

Reported hate-crimes on the rise in Europe

The number of reported hate-crimes against LGBT people have increased over the last few years in European countries  according to the European Region of the International Lesbian, Gay, Bisexual, Trans & Intersex Association (ILGA Europe)—but these reports are considered the tip of an iceberg by the organization.

“All our member organizations agree that there is a very high rate of under-reporting of hate-crimes,” says Joel Le Deroff, Policy and Programmes officer at ILGA Europe. “The paradox is that a high number of incidences reported, usually means that there is confidence between the law enforcement agencies and the victims.”

That is why it is difficult to know if this trend in increasing number of cases reported represents an actual increase in the number of hate-crimes committed, or a positive change in the environment which promotes the reporting of abuse. One thing that Mr Le Deroff is certain of is that the LGBT community should work together with law enforcement agencies. This to establish the trust needed for people who experience discrimination and violence based on their sexual orientation to report it.

Protective laws and social change

In Denmark, a country generally considered progressive and liberal with regards to sexuality, very little is known about the extent and character of hate crimes against members of the LGBT community according to a recent report by the European Union Agency for Fundamental Rights.

In 2007 a Danish LGBT online portal conducted a survey among their users on whether they had experienced hate crimes on grounds of their sexuality. Of the 9473 respondents, 12% stated that they had experienced physical assaults and 39% reported verbal assaults.

Steffen Jensen, spokesperson for international policy of the Danish National Association for Gay Men, Lesbians, Bisexuals and Transgendered People noted: “the general attitude towards minorities is shifting towards a less tolerant one. We need broad public awareness campaigns, basic information to everybody, and most importantly: education!”

Homophobia and health

The stigma and discrimination that results from homophobia affects whether or not members of the LGBT community are able to seek and obtain the health services that they need. The social marginalization of people who engage in same-sex relationships acts as a barrier to access HIV prevention, treatment, care and support services.

Prevalence of HIV among men who have sex with men and transgender people is almost always higher than the general population. In France, for example, men who have sex with men have an estimated HIV prevalence that is nearly 100 times higher than the national average.

According to Mr Collins from amfAR, homophobia has important implications for both the physical and mental health of LGBT people. A recent study in the USA showed that among LGBT adults people who had experienced strong rejection by their families were 3.4 times more likely to have risky sex and 8.4 times more likely to have tried to commit suicide as compared to people with supportive families.

Political leadership vital

Homophobia can also lead to unwillingness on part of political leaders to invest in the health of men who have sex with men, transgender people and other gender variant individuals.

A study in Italy from 2005 found that one third of the gay male respondents found it difficult to find information about which sexual behaviors carry risk of HIV infection. A majority of the respondents did not identify as gay to their doctors, and one in three was afraid that they would receive worse treatment from health workers because of their sexual orientation.

In 2009 a bill was put before the Italian Parliament to expand provisions for punishing hate crimes and incitation to hatred based on race, ethnicity, or religion to cover crime motivated by homophobia or transphobia—this bill was rejected. The United Nations High Commissioner for Human Rights declared it a step back for human rights in Italy.

“When the Italian parliament rejected this bill, it sent a message to us that hate-crimes were not part of the political priorities and that homophobia is legitimate,” said Mr Le Deroff from ILGA Europe.

It’s clear that the connections between human rights violations, homophobia and health are many. The nuances and different levels of discrimination ranges from the most blatant institutional discrimination outlawing same sex behavior, to not disclosing sexual orientation to a health care professional for fear of ridicule. To ensure an environment where people can live, work and love safely, governments need not only to fulfill and protect the rights of people within LGBT community, but also promote these rights.

UNAIDS is committed to empower all people, regardless of sexual orientation, to protect themselves from HIV infection and for all people living with HIV who need it to fully access antiretroviral therapy. This means ensuring that law enforcement agencies and the judicial system protects the rights of all people, including members of the LGBT community. It also means tackling homophobic sentiments that block an effective response to HIV, wherever such sentiments may exist.

Michel Sidibé, Executive Director of UNAIDS, at the XIII Francophone summit in Montreux. 23 October, 2010. Credit: UNAIDS/Chironi

UNAIDS and the Global Fund Fight AIDS, Tuberculosis and Malaria and partners have joined together at the XIII Francophone summit in Montreux, Switzerland to explore ways of strengthening the response to HIV in francophone countries.

Sharing expertise and knowledge in the AIDS response among the 70 francophone countries around the world could significantly reduce new HIV infections and increase access to HIV services for people most in need expanded.

“Francophone leaders must continue to push the response forward, not only in their countries but also beyond and across the francophone network,” said Michel Sidibé, Executive Director of UNAIDS. “By creating a pool of knowledge of what works best in the AIDS response, francophone nations can draw on these resources and apply them to the response in their own countries.”

Better collaboration between francophone countries would create a wide database of expertise and experience which can be shared between countries to develop a more effective and efficient response to the epidemic.

Exchanging information about the mobilisation of resources, efficient use of resources, and the development of innovative sources of financing will also help to ensure a sustained and continued response to the epidemic in times of global financial difficulty.

“The Francophone Summit is an important forum which unites Global Fund donor and recipient countries,” said Michel Kazatchkine, Executive Director of the Global Fund. “It is an essential bridge between the north and the south which reinforces partnerships, not only between states and civil society organisations, but also more and more with the private sector which is strengthening the response the response to AIDS, and to tuberculosis and malaria.”  

Francophone countries in Africa, South East Asia and the Caribbean bear a significant burden of the global AIDS epidemic. In 2008 there were more than 4 million people living with HIV in francophone countries, and 340 000 new HIV infections, most of which were in Africa.

The discussions took place during a roundtable at the XIII Francophone Summit in Montreux, Switzerland where 3000 delegates including heads of state and high-level representatives from 70 francophone countries had gathered to foster relationships between francophone countries.

UNAIDS Executive Director, Michel Sidibé and Dr Christian MÉsenge Director of the Health Department at Senghor University of Alexandria. Credit: UNAIDS/Chironi

UNAIDS and the Senghor University of Alexandria signed an agreement of cooperation to include a 25 hour module specific to AIDS in the university’s curriculum of their Master’s degree on Health.

The memorandum of understanding was signed in Geneva on 21 October 2010 by UNAIDS Executive Director, Michel Sidibé and Mr Albert Lourde, Rector of the Senghor University.

The agreement also established that a selected group of students cursing the second year of the master’s degree will have the opportunity to undertake their mandatory 3 months internship in several UNAIDS country offices located in West and Central Africa as well as the Middle East and North Africa regions.

UNAIDS will also certify the continuing education courses organized by the University throughout the francophone Africa when such courses are related to AIDS.

This initiative is a consequence of the broader cooperation agreement between UNAIDS and the International Organisation of La Francophonie (IOF) signed in December 2009 focusing on institutional dialogue between governments, partners, stakeholders in the field and civil society. The IOF and UNAIDS strengthened their collaboration for the benefit of the peoples of the French-speaking world, specifically the most vulnerable.

The main areas of cooperation, which were identified with the Operating agencies of La Francophonie, could thus be embodied in new tailor-made agreements built around the themes of democracy and human rights, including legislative aspects of HIV, and education and research, in conjunction with the University Agency of La Francophonie (AUF) and the Senghor University of Alexandria.

This new agreement signed with Senghor University embodies the ties between UNAIDS and La Francophonie by building the capacity of the francophone countries in terms of human resources as well as raising awareness of the AIDS epidemic and UNAIDS work.