UNAIDS Deputy Executive Director, Management and External Relations Branch, Ms Jan Beagle addressed a meeting of funders committed to end mother-to-child transmission of HIV by 2015. Credit: UNAIDS/Anna Rauchenberger

Continuing UNAIDS' efforts to end mother-to-child transmission of HIV by 2015, earlier today, UNAIDS Deputy Executive Director, Management and External Relations Branch, Ms Jan Beagle addressed a meeting of funders already committed to this action, at a side event of the XVIII International AIDS Conference in Vienna.

Bringing together funders from around the world who are focused on HIV, reproductive health, and maternal and child health—including private foundations, family foundations, and corporations—the meeting provided an inspirational platform, addressing how these stakeholders can strengthen and align their responses.

Ms Beagle noted that in 2008 an estimated 280,000 children under fifteen died of HIV-related causes. Most of these children were under the age of five and were infected through their mothers either during pregnancy, labour and delivery, or through breastfeeding, and over 90% lived in Sub-Saharan Africa.

“By contrast, mother-to-child transmission of HIV has been almost eliminated in high-income countries,” said Ms Beagle. “It is an immense injustice that mother-to-child transmission of HIV has not yet been eliminated globally. It is achievable and doable across the world in a business timeframe i.e. by 2015.”

Ms Beagle encouraged those present to join the global effort and understand the role they can play to support unmet needs through financial and non-financial contributions.

On the benefits of preventing HIV infections in children, Ms Beagle noted, “Imagine the impact that it would have on families and communities, in terms of educated societies and productivity.”

Mother-to-child HIV transmission

An estimated 430,000 children were infected with HIV in 2008. However significant progress in ending mother-to-child transmission has occurred in recent years. In 2008 around 45% of pregnant women living with HIV in low- and middle-income countries received antiretroviral drugs compared with only 10% in 2004. Despite these successes, across the world each year over a million pregnant women risk passing along HIV to their child.

UNAIDS Executive Director Mr Michel Sidibé has called for the virtual elimination of mother-to-child HIV transmission by 2015 and efforts are gaining momentum around the world.

Preventing mothers from dying and babies from becoming infected with HIV is also one of UNAIDS’ key priority areas as outlined in its 2009 – 2011 Outcome Framework. UNAIDS calls for the scaling up of access to and the use of quality services for the prevention of mother-to-child transmission as an integral part of sexual and reproductive health services and reproductive rights for women, their partners and young people.

The event was hosted by Johnson & Johnson and co-partners included UNAIDS, Funders Concerned About AIDS, Global Business Coalition for HIV/AIDS, TB, Malaria, and the European Funders Group.

From left: Ambassador Eric Goosby, United States Global AIDS Coordinator; Professor Michel D. Kazatchkine; Executive Director, The Global Fund to Fight AIDS, TB and Malaria; Anthony Lake, Executive Director of UNICEF; Michel Sidibé, Executive Director of UNAIDS; Hiroki Nakatami, Assistant Director General of WHO; at the UNAIDS PMTCT Satellite at the 18th International AIDS Conference in Vienna, Austria on 19 July 2010. Credit: UNAIDS/Heimo Aga

UNAIDS hosted a satellite at AIDS 2010 on preventing mother-to-child transmission of HIV 19 July. It was co-chaired by Antony Lake, Executive Director of UNICEF and Hiroki Nakatani, Assistant Director General of World Health Organization (WHO) and coordinated by Gottfried Hirnschall, Director of the HIV department (WHO). Opening remarks were delivered by Michel Sidibé, Executive Director of UNAIDS and Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria, and Ambassador Eric Goosby, United States Global AIDS Coordinator.

The call to eliminate mother-to-child transmission of HIV was first made by UNAIDS Executive Director Michel Sidibé and he has since been joined by leaders of nations, heads of multilateral, bilateral, regional and national bodies, presidents of foundations, members of civil society, and even captains of football teams in the FIFA 2010 World Cup.

From left: Professor Michel D. Kazatchkine; Executive Director, The Global Fund to Fight AIDS, TB and Malaria; Anthony Lake, Executive Director of UNICEF; Michel Sidibé, Executive Director of UNAIDS; Hiroki Nakatami, Assistant Director General of WHO; at the UNAIDS PMTCT Satellite at the 18th International AIDS Conference in Vienna, Austria on 19 July 2010. Credit: UNAIDS/Heimo Aga

Addressing the satellite, Mr Sidibé noted that many African countries like Botswana, Namibia and Swaziland are already leading the way towards virtual elimination if mother-to-child transmission, and many others are close behind.

This groundswell of support is lending hope to the possibility that transmission of HIV from mothers to children can be virtually eliminated in the highest-burden countries by 2015. At the same time, the WHO has issued new recommendations on the use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants and HIV and infant feeding. The main purpose of the new recommendations is to improve maternal and child survival by drastically reducing risk to around 5%, including in breastfeeding populations.

WHO, UNICEF, UNFPA and UNAIDS have developed a PMTCT strategic vision through the UNAIDS Outcome Framework for 2009-2011, aiming at defining joint commitment to support scale up of PMTCT of HIV services and integration with maternal, newborn and child and reproductive health services.

A long way to go

Despite this momentum, many nations have a long way to go. The majority of pregnant women in low- and middle-income countries do not know their HIV status. This knowledge has risen from 7% in 2004 to 21% in 2008. Also, the majority of HIV-positive pregnant women who need antiretrovirals (ARVs) for preventing transmission of the virus to their child. Only 45% of women in need of ARVs received it in 2008, although this is up from 10% in 2004.

UNAIDS PMTCT Satellite at the 18th International AIDS Conference in Vienna, Austria on 19 July 2010. Credit: UNAIDS/Heimo Aga

The quadrupling of the proportion of women receiving this important service is good news. But children continue to be left behind. Around 32% of infants born to HIV-positive mothers received antiretroviral for PMTCT in 2008, up from 20% in 2007 and 6% in 2004.

Update

Yesterday’s satellite provided an update on global commitments to virtual eliminate mother-to-child transmission of HIV. Participants highlighted key policy and operational considerations in implementing comprehensive PMTCT services integrated with maternal health and family planning services, including the WHO 2009 guidelines on ARV drugs for treating pregnant women and preventing HIV infection in infants which were reviewed by Nathan Shaffer of WHO.

To put theory into perspective country experience was shared by Mpolai Moteetee, the PMTCT focal point in Lesotho's Ministry of Health and Social Welfare Family Health Division who spoke of the experience of rapid scale-up of PMTCT services in Lesotho.

Marie Deschamps of GHESKIO (Groupe Haïtien d’étude du Sarcome de Kaposi et des Infectieuses Opportunistes) presented on the importance of integration of broad range of services of maternal health, family planning, PMTCT, and HIV treatment for maternal and child survival

Lilian Mworeko of ICW (International Community of Women with HIV/AIDS) Uganda shared her personal perspective as an activist and a person living with HIV.

Mother-Baby Pack

UNICEF, in collaboration with WHO and global partners, has developed an innovative simple, user-friendly and affordable packaging mechanism to deliver PMTCT preventive medications, the Mother-Baby Pack (MBP). Chewe Luo, a UNICEF Senior Advisor, presented the Pack which contains medicines for prophylaxis, ARVs and Co-trimoxazole, for the mother and for the infant in line with WHO 2010 PMTCT Guidelines. It also intends to help streamline procurement and supply management of PMTCT medicines.

The Global Fund has also declared preventing mother-to-child transmission (PMTCT) a priority and is currently assessing the possibility of reprogramming existing grants to accelerate scale-up in 20 countries (Angola, Botswana, Burundi, Cameroon, Côte d'Ivoire, the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Lesotho, Mozambique, Malawi, Namibia, Nigeria, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe).

Caroline Ryan of PEPFAR shared how their efforts will contribute towards virtual eiliminaiton. PEPFAR II has aligned its target to the UNGASS targets aiming to provide PMTCT services to 80% of all pregnant women living with HIV and exposed infants in their country programmes. All these commitments fall within the context of integrated programming for improved maternal and child health and survival coordinated with current US Global Health Initiative.

Closing remarks at the session were delivered by Antony Lake and Hiroki Nakatani.

UNAIDS Goodwill Ambassador HRH Mette-Marit, Crown Princess of Norway
Credit: UNAIDS/Anna Rauchenberger

UNAIDS Goodwill Ambassador HRH Mette-Marit, Crown Princess of Norway, joined UNAIDS Deputy Executive Director, Management and External Relations Branch, Ms Jan Beagle and Dr Julio Montaner, International Chair of the XVIII International AIDS Conference and President of the International AIDS Society in welcoming young participants to the Youth Pavilion at XVIII International AIDS Conference.

UNAIDS Deputy Executive Director, Management and External Relations Branch, Ms Jan Beagle
Credit: UNAIDS/Anna Rauchenberger

HRH Mette-Marit, who has made the needs of young people her primary focus as UNAIDS Goodwill Ambassador encouraged the young delegates saying, “We need to recognize youth as global citizens instrumental in understanding and driving the change that is needed in the new AIDS response... Make it happen now!”

With a message of support Ms Jan Beagle said, UNAIDS is committed to create a movement of young people as change agents for a new generation of leadership in the AIDS response.

In the coming week a series of Pavilion Talks will take place to enhance cooperation between young people and scientists, activists and other high-level stakeholders.
Credit: UNAIDS/Anna Rauchenberger

“UNAIDS is committed to empower young people, providing them space to inform our policy and programming and to inspire UNAIDS with a youth spirit,” said Ms Beagle.

The Youth Pavilion is an interactive space in the Global Village of AIDS 2010 for young people to showcase projects and performances, and meet delegates, plenary speakers and decision-makers.

The Opening Ceremony was highly interactive and included a flash mob event where young people throughout the Global Village put on YouthForce T-Shirts and moved en masse towards the Youth Pavilion.

The opening was co-chaired by the Youth Programme Working Group Co-Chairs Liping Mian (China) and Korey Anthony Chisholm (Guyana) who talked about the global HIV youth movement and introduced the youth activities during AIDS 2010 including the AIDS 2010 Youth Programme and Vienna YouthForce activities.  

They also introduced the “3 HRs” campaign promote human rights, harm reduction and health resources as a framework to achieve HIV services for young people. By highlighting these “3 HRs” to policy experts and decision-makers in the coming week, young people hope to highlight their needs in the AIDS response.

Pavilion Talks

In the coming week a series of Pavilion Talks will take place to enhance cooperation between young people and scientists, activists and other high-level stakeholders. These will be designed by young people and provide space for questions and discussion. It will be opened each day by a youth rapporteur who will present the highlights of the previous day and give a brief summary of the morning plenary session.

Legal frameworks can be powerful tools for countries struggling to control their epidemics. The last three decades have given rise to contentious legal debates on HIV-related issues (e.g.: criminalization of HIV transmission; legal restrictions on needle and syringe distribution in the US, on methadone in Russia, versus legal comprehensive harm reduction in Australia).  The last few years have seen an insurgence of punitive laws and practices related to drug use, HIV transmission and exposure, sex work, and same sex sexual relations. There is also a growing body of evidence on the relationship between HIV and violence against women.

There is enough variation in legal responses to HIV around the world to highlight the need to rigorously examine the impact of different legal environments on HIV outcomes and to make appropriate recommendations. According to Jeffrey O’Malley, Director of the United Nations Development Programme’s HIV/AIDS Practice, “Thirty years on, there is a huge variation from one country to the next in terms of HIV prevention results.  It is increasingly clear that one of the most influential factors is the legal environment.  Does the law facilitate and enable HIV prevention and care or does it stand in the way?  We need to understand both cases and to promote good practice.”

Right here, right now is the time to take a hard look at how legal environments affect HIV responses. As highlighted in the Vienna Declaration, the relationship between legal environments and epidemiological trends in Eastern Europe offers an example of the ways in which legal frameworks can impact HIV epidemics. The Global Commission on HIV and the Law “provides a timely opportunity to take stock of the impact of punitive laws and practices on the lives of those most marginalized in our societies and on their access to life-saving HIV prevention and treatment services. For this reason, Australia is pleased to be supporting this endeavour. We hope other donors will follow suit,” says Mr. Murray Proctor, Australia’s AIDS Ambassador.

The Global Commission on HIV and the Law will explore the impacts of legal environments on HIV responses. Areas of inquiry may include: (1) punitive laws and practices that effectively criminalise lives (2) laws and practices that sustain violence and discrimination as lived by women (3) laws and practices that impede treatment access.  The Commission’s work will take place over an 18 month period –mobilizing communities across the globe and promoting public dialogue on how to make the law work for an effective response to HIV. The findings and recommendations of the Commission will be announced in December 2011.

The Commission, which brings together eminent leaders from many walks of life and regions, will interrogate the legal environments that form the context of national HIV responses.  Experts on law, public health, human rights, and HIV will support the Commissions’ work. Commissioners will assess evidence about the impact of law and law enforcement on the lives of people living with HIV and those most vulnerable to it.  Regional dialogues will provide a space in which those most directly affected by HIV-related laws can share their experiences with policy and law makers.  As noted by Commissioner H.E. Festus Mogae, former President of Botswana, “HIV threatens us all. HIV is a global problem and the promise of an AIDS-free generation requires bold global leadership. This Commission is an important expression of the commitment and leadership of the global community to meet the needs most vulnerable to HIV.”

World Health Organization advises earlier treatment among people with HIV

19 July 2010, Vienna - An estimated 5.2 million people in low-and middle-income countries were receiving life-saving HIV treatment at the end of 2009, according to the latest update from the World Health Organization (WHO).

WHO estimates that 1.2 million people started treatment in 2009, bringing the total number of people receiving treatment to 5.2 million, compared to 4 million at the end of 2008.

"This is the largest increase in people accessing treatment in a single year. It is an extremely encouraging development," says Dr Hiroki Nakatani, WHO Assistant Director-General for HIV, Tuberculosis, Malaria and Neglected Tropical Diseases.

At the XVIII International AIDS Conference, WHO is calling for earlier treatment for people with HIV. The objective is to begin HIV treatment before they become ill because of weakened immunity.

"Starting treatment earlier gives us an opportunity to enable people living with HIV to stay healthier and live longer,” says Dr Gottfried Hirnschall, WHO Director of HIV/AIDS.

Estimates developed through epidemiological modeling suggest that HIV-related mortality can be reduced by 20% between 2010 and 2015 if these guidelines for early treatment are broadly implemented.

Earlier treatment can prevent opportunistic infections including tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90%, if people with both HIV and TB start treatment earlier.

The strength of a person's immune system is measured by CD4 cells. A healthy person has a CD4 count of 1000 - 1500 cells/mm3. WHO previously recommended starting HIV treatment when a person's CD4 count drops below 200 cells/mm3 but now advises starting HIV treatment at 350 cells/mm3 or below.

"In addition to saving lives, earlier treatment also has prevention benefits,” Dr Hirnschall says. “Because treatment reduces the level of virus in the body, it means HIV-positive people are less likely to pass the virus on to their partners."

WHO's treatment guidelines expand the number of people recommended for HIV treatment from an estimated 10 million to an estimated 15 million. The cost needed for HIV treatment in 2010 will be about US$ 9 billion, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

"The investments we make today can not only save millions of lives but millions of dollars tomorrow,” said Dr Bernhard Schwartlander, Director, Evidence, Strategy and Results, UNAIDS. "People with weaker immune systems who come late for treatment require more complex and costly drugs and services than those who start treatment earlier and are healthier."

Since 2003 - which marked the launch of the historic “3 by 5” initiative to provide access to HIV treatment to 3 million people living in low- and middle-income countries by the end of 2005 - the number of people receiving HIV treatment has increased 12-fold.

At AIDS 2010, WHO is releasing the 2010 guidelines on “Antiretroviral treatment of HIV infection in adults and adolescents – public health approach”, which can be found at www.who.int/hiv.

From the left: Mirta Roses; Tripti Tandon at ‘Human Rights based approach to HIV Prevention: Mission Impossible’, 18 July 2010. Credit: UNAIDS/Anna Rauchenberger

The Global Village of AIDS 2010 was the setting of a UNAIDS satellite session on HIV prevention and human rights. Participants discussed how evidence-informed and rights-based laws, policies and programmes can be scaled-up in support of a ‘prevention revolution’ to break the trajectory of the epidemic.

Panelists highlighted some enduring failures to recognise and protect human rights in the context of prevention, as well as examples of successful prevention responses employing a human rights-based approach.  Notwithstanding some key challenges, the unanimous view of the diverse expert panel was that such an approach to prevention is not mission impossible if current opportunities to put human rights at the centre of the prevention revolution are seized. Indeed, it was felt that there can be no ‘revolution’ of the prevention response without human rights.

The event, which used a talk show format to encourage open dialogue and audience participation, was moderated by Dr Mandeep Dhaliwal, Cluster Leader of Human Rights, Gender and Sexual Diversity at the United Nations Development Programme (UNDP).

From the left: Daouda Diouf; Carlos Passarelli at ‘Human Rights based approach to HIV Prevention: Mission Impossible’, 18 July 2010.
Credit: UNAIDS/Anna Rauchenberger

Six panelists from a range of perspectives and experiences including governments, civil society and the United Nations, presented their views on whether human rights have been used effectively to drive action towards universal access to HIV prevention, treatment, care and support. 

Mr Carlos Passarelli of the Government of Brazil spoke about his country’s experience and success in HIV prevention which, he said would not have occurred without a human rights-based approach.

Speaking from first-hand knowledge, Ms Olimbi Hoxhaj of the Albanian Network of People Living with HIV, told the session about her experience in using arguments based on human rights and equality in order to get her children into school and gain access to treatment for those who were HIV-positive. 

Meena Seshu at ‘Human Rights based approach to HIV Prevention: Mission Impossible’, 18 July 2010.
Credit: UNAIDS/Anna Rauchenberger

Ms Meena Seshu described how female, male and transgender sex workers’ access to health and HIV prevention was being undermined by the fact that their rights to the highest standards of health and to safe working conditions were not being protected. Ms Seshu is a member of SANGRAM, an Indian grass-roots peer education organisation partnering with women in sex work to promote their rights and encourage them to be agents of change.

Other panelists included Tripti Tandon from the Lawyers’ Collective in India, Dr Mirta Roses, Director of the Pan American Health Organisation, PAHO and Daouda Diouf of the international NGO Enda Sante.

A human rights-based approach to mitigating the extent and effects of the AIDS epidemic, and promoting universal access to HIV services is seen as critical. Although there has been notable progress in many areas, punitive laws, policies, practices and stigma and discrimination continue to undermine the achievement of universal access targets including access to prevention for those who need it – and the Millennium Development Goals.

Panelists emphasized that a prevention revolution must be grounded in human rights if there is to be a significant and sustainable improvement in the prevention response. In summing up the discussion at the Satellite, Mandeep Dhaliwal noted that the experiences shared confirmed that success in prevention can only be achieved in legal and social environments that advance human rights, gender equality and social justice.

She emphasised the importance of the UNAIDS High Level Commission on HIV Prevention putting the issue of human rights – for so long poorly understood and neglected in the prevention response  -  at the front and centre of its work.  “After all, what good is a prevention revolution without human rights?”

Opening ceremony of AIDS 2010. Credit: UNAIDS/Heimo Aga

The XVIII International AIDS Conference opened on Sunday 18 July in the city of Vienna. With open arms, Austria has welcomed an estimated 20,000 delegates from all over the world who will spend the next week taking part in conference sessions and satellite meetings under the theme “Rights Here, Right Now” selected to emphasize the critical connection between human rights and HIV.

The opening ceremony began with a video message form Secretary-General Ban-Ki Moon reiterating UNAIDS’ new vision for the AIDS response: zero new infections, zero discrimination and zero AIDS-related deaths.

The Executive Director of UNAIDS, Mr Michel Sidibé, in his speech to delegates, stressed that this conference comes at a defining moment in the AIDS response. He focused his remarks on the transformation that is required to break the trajectory of the epidemic.

Mr Sidibé spoke on the urgency for a new approach to antiretroviral treatment, and introduced Treatment 2.0.

“Treatment 2.0 radically simplifies treatment to maximize the number of people who can benefit. This will save more money. But in the end, we will only be measured by the number of lives we save,” he said.

This new treatment model is also relevant in the European context said John Dalli, European Union Commissioner of Health and Consumer Policy. Mr Dalli stressed that there are major treatment inequalities across the European Union, with cost of treatment differing from country to country and treatment stocks sometimes running out. He said now is the time to turn targets into tangible results.

A message of commitment to activism was delivered by the singer and activist Ms Annie Lennox, who was recently appointed UNAIDS International Goodwill ambassador.

“HIV should not be stigmatized, it should be normalized” said Ms Lennox “There must be no more discrimination of HIV.”

Remarks were also made by Ms Brigitte Schmied, president of the Austrian AIDS Society and local chairperson of the conference, as well as by Dr Julio Montaner, the president of the International AIDS Society, who echoed Mr Sidibé’s call for Treatment 2.0. “Treatment 2.0 is the single most important thing coming out of this meeting”, said Dr Montaner. “Let’s rally behind it, and let’s rally behind universal access.”

The community welcome was given by Vladimir Zhovtiak from Ukraine and Sasha Volgina from the Russian Federation. They delivered a joint address on the urgency of the HIV epidemic in the eastern Europe and central Asian region. “The epidemic in our region is the fastest growing epidemic in the world. We are dying less, but we are dying faster”, said Ms Volgina.

Twenty-two year old Rachel Arinii, a regional member of the Global Youth Coalition on HIV/AIDS from Indonesia, delivered inspiring remarks representing all young people at AIDS 2010. “Young people are too young to die. We call on our leaders to provide evidence-based sexuality education in and out of schools,” said Ms Arinii.

The Federal President of Austria, Mr Heinz Fisher, closed the ceremony where he welcomed the delegates to the conference as well as the country.

AIDS 2010 is convened by the International AIDS Society in partnership with a number of international, regional and local partners. These include local scientific leadership, the City of Vienna and the Government of Austria, Aids Hilfe Wien, Austrian AIDS Society, East European & Central Asian Union of PLWH (ECUO), European AIDS Clinical Society (EACS) and the European Commission.

International partners for AIDS 2010 include Joint United Nations Programme on HIV/AIDS (UNAIDS), including its co-sponsors, the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC), International Council of AIDS Service Organizations (ICASO), Global Network of People Living with HIV/AIDS(GNP+)/International Community of Women Living with HIV/AIDS (ICW), World YWCA and Caribbean Vulnerable Communities Coalition (CVC).

AIDS 2010, as the conference is widely known, is the premier gathering for people working in the field of HIV, as well as policy makers, people living with HIV and other individuals committed to ending the epidemic. The event, the largest AIDS conference in the world, is held every two years.

Located at the heart of Europe, the conference will put the spotlight on HIV epidemics in Eastern European and Central Asia, the only region where HIV prevalence clearly remains on the rise. The conference programme will present new scientific knowledge and offer opportunities for structured dialogue on the major issues facing the global response to HIV. Other related activities, including the Global Village with its cultural program, exhibitions and affiliated events will open up space for dialogue and reflection.

The conference runs until the 23 July, 2010.

From the left: Maria Antoniela Alcalde, Paul de Lay, UNAIDS Deputy Executive Director; Olayide Akanni; Kieran Daly, Elena Grigoryeva at the‘ICASO satellite on Universal Access’, Session Room 7 at AIDS 2010, Vienna, Austria on 19 July 2010
Credit: UNAIDS/Anna Rauchenberger

At a satellite session on universal access to HIV prevention, treatment, care and support, panelists discussed target setting and review process to date, drawing on community analysis from countries over the last few years. The session aimed to start a debate on how, in many countries, genuine targets for universal access (UA) are not being set, especially for populations at higher risk of HIV infection.

The session, titled 'Fool me Once, Shame on you... Fool me twice, Shame on me: Key population leadership for Universal Access', was organised by the International Council of AIDS Service Organizations (ICASO).

Panelists included UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay, who discussed UNAIDS' analysis of the current situation, particularly at the country level, including target setting for key populations.

“Significant strides have been made since 2006 in achieving universal access, such as a 12-fold increase in access to services for prevention of mother-to-child HIV transmission, but by the end of 2010, only one-third of countries will have reached the UA targets they set,” said Dr De Lay.

“National targets need to be set that get at the heart of the issues facing vulnerable and key populations,” he added.

Talking about UNAIDS' commitment to providing universal access, Dr De Lay said, "It may be tempting to blame someone for not reaching universal access. But we need to keep ourselves focused on what we need to do, rather than what we did not yet do."

In 2006 governments committed, in the form of a Political Declaration on HIV/AIDS, to providing universal access to HIV prevention, treatment, care and support services to all those in need by 2010. During its recent Programme Coordinating Board meeting, UNAIDS proposed to call on the General Assembly to extend the commitment to universal access to 2015, and to report back on its progress in June 2016. This was not without reason.

Over the past years many countries have brought in new legislation protecting the rights of key populations, particularly those of men who have sex with men and transgender communities. While on the other hand, there still remain several others that have new legislation, or are planning new legislation, that will drive key populations further away from services.

"As you see a polarization of conservative and liberal values in individual countries, we see this playing out on the world stage," Dr De Lay explained.

In such a scenario, there is a need to revitalize monitoring to assist countries and set targets that will reduce sexual transmission, empower men who have sex with men, sex workers and transgender people to protect themselves, protect drug users from becoming infected and remove punitive laws, policies and practices, stigma and discrimination.

Ahead of the official opening of the XVIII International AIDS Conference, a town hall event saw the coming together of influential leaders in the AIDS response to share their insights of what the future of HIV prevention and treatment must look like if the goal of zero new infections and zero AIDS deaths is to be reached by 2015.

Organized by UNAIDS and the International AIDS Society (IAS), the town hall event “Towards a paradigm shift in HIV treatment and prevention” engaged dynamic leaders Kgalema Motlanthe, Deputy President of South Africa, Michel Sidibé, Executive Director of UNAIDS, and Julio Montaner, President of the International AIDS Society, in a discussion on HIV prevention, treatment, investments and human rights.

The Deputy President of South Africa underscored his country’s commitment to the HIV response despite the financial crisis that threaten gains made, such as increased access to treatment and for the first time declining rates of new HIV infections among young people.

“Even as the world experiences an economic downturn, investments in the fight against HIV must not be the soft target for austerity measures,” said Mr. Motlanthe. “South Africa has prioritized the AIDS response as an investment in life, hope, health systems, and human development with the view to improve the quality of life.”

By taking AIDS further out of isolation, the Deputy President underscored that his country could see significant reductions in maternal and infant deaths. He called on all countries to renew the commitment to universal access by bringing it in line with the MDG timeframe of 2015.

Following Mr. Motlanthe’s speech, Mr. Sidibé spoke on Treatment 2.0, a radically simplified treatment platform that UNAIDS believes could have secondary benefits for prevention. “Let’s be realistic: Costs for treatment are rising. People are starting to lose hope and we need to bring the hope back,” said Mr. Sidibé. “We need drugs that are cheaper, easier to administer, and diagnostics that are simpler to use. Treatment for prevention is not just a dream. It is possible if we share the responsibility.”

Together with Treatment 2.0, Mr. Sidibé said a ‘prevention revolution’ is required to break the trajectory of the epidemic. He said this revolution will not happen without “prevention diplomacy” with the leaders like those who were assembled at the town hall.

Julio Montaner, IAS President, shared his optimism for the merging of prevention and treatment efforts and said that by treating more people, new HIV infections can be reduced.

Following the opening segment, the town hall’s host, James Chau, news anchor with China Central Television (CCTV) and a UNAIDS National Goodwill Ambassador for China, engaged the audience in an interactive panel discussion on prevention and treatment with Barbara Lee, US Congresswoman, 9th District of California, Rolake Odetoyinbo, Executive Director of Positive Action for Treatment Access, Mphu Ramatlapeng, Minister of Health and Social Welfare of Lesotho, and Claudia Ahumada of the World AIDS Campaign.

The panellists shared their personal perspectives of the challenges and progress in implementing HIV prevention, treatment, care and support services as well as ensuring human rights.

The town hall featured a special appearance of UNAIDS International Goodwill Ambassador Annie Lennox who spoke passionately on why she is engaged in the response.

“I don’t want to see any mother die of a preventable disease. Why should that be?” she asked the audience. “HIV is the leading killer of women of reproductive age globally. Why doesn’t the world respond to this? I will keep campaigning until we see the kind of changes Michel Sidibé is talking about.”

Ms Lennox closed the event by asking the leaders and activists who shared the stage and those in the audience to “recommit to the response and take it further.”

HRH the Crown Princess of Norway and UNAIDS Executive Director Mr Michel Sidibé, Vienna, 17 July 2010. Credit: UNAIDS/Heimo Aga 

Young leaders from around the world joined HRH the Crown Princess of Norway and UNAIDS Executive Director Mr Michel Sidibé and others to exchange experiences on leadership in the AIDS response during a formal and an informal session on 17 July 2010 at AIDS 2010.

Bringing together current leaders with an emerging generation of young leaders, the afternoon sessions were an opportunity to share experiences and exchange ideas on the concept of “new generation leadership” between established and young leaders and identify the potential opportunities.

New Generation Leadership

Based on recommendations of young leaders during the Young Leaders Summit in Oslo, Norway in June 2009, new generation leadership hopes to increase the participation of young people in policy-making and help foster a new generation of leadership.

UNAIDS Goodwill Ambassador, Her Royal Highness Crown Princess Mette-Marit of Norway is committed to supporting the issue of new generation leadership in the AIDS response. Noting the importance of this approach, HRH Mette-Marit said, “In my role with UNAIDS I consider helping to strengthen young leadership to be my most important task.”

“We are at a crossroads and we need young people to be at the forefront of our efforts. Join me to pave the way for new leaders," HRH Princess Mette-Marit added.

HIV Youth Mentorship Hub

The UNAIDS Executive Director, calling for “young leaders of today, not for tomorrow,” also launched the concept of an HIV Youth Mentorship Hub. The Hub is envisaged as a mechanism to strengthen the visibility and effectiveness of youth leadership in the global AIDS response. Through its online community e-platform, AIDSspace, the Joint Programme hopes to provide a structured opportunity to connect established leaders in the HIV response with emerging young leaders. The young leaders and their respective mentors would be able to interact and discuss issues related to HIV prevention, treatment, care and support.

The HIV Youth Mentorship Hub also aims to make a repository of knowledge and skills in youth leadership available. This will enable young people to shape the implementation of effective HIV programmes and to foster a youth movement to reduce new HIV infection among young people.

Support for youth leadership is a key priority for UNAIDS. According to its Outcome Framework 2010-2011, the Joint Programme strives towards "Empowering young people to protect themselves from HIV" as one of its ten priority areas. The New Generation Leadership programme and HIV Youth Mentorship Hubs are steps in this direction.

As Paddy Masembe, a delegate representing the Uganda Network of Young People Living with HIV, pointed out at today’s event, the youth voice is critical, “People say young people are too young to discuss sex, but we are too young to die!”