The President of Fiji, His Excellency Ratu Epeli Nailatikau receives the Commission on AIDS in the Pacific Report from Commission Chairperson and Deputy Prime Minister of Samoa, Hon. Misa Telefoni Retzlaff during the launch ceremony in Suva Fiji 26 April 2010.

The country launch of the Commission on AIDS in the Pacific Report Turning the Tide: An OPEN Strategy for a response to AIDS in the Pacific took place in Suva, Fiji on 26 April 2010. The report was presented to His Excellency President Ratu Epeli Nailatikau and representatives of the Pacific Regional organisations by Commission Chair and Samoa’s Deputy Prime Minister, Misa Telefoni Retzlaff.

Officially launched by the UN Secretary-General in New York on 2 December 2009, the report presented in Papua New Guinea on 11 March and launched in Samoa on 22 April 2010 by Tuilaepa Lupesoliai Sailele Malielegaoi, the Prime Minister of Samoa.

Turning the Tide outlines the key challenges blocking the AIDS response in the Pacific and presents decisive steps countries in the region should take to protect their societies, cultures and economies from HIV. In addition, the report states that a “one size fits all” response does not suit the diversity of Pacific nations and outdated legislation criminalizing homosexuality and commercial sex is a major impediment in the region.

According to the report, as strong family and faith-based ties are central to life in the Pacific, any hope for success addressing the epidemic depends on integrating responses to HIV within these social structures. The report also recommends that greater involvement of people living with HIV in matters of policy making and programme delivery will strengthen the response.

Speaking at the Fiji launch, UNAIDS Regional Director for Asia and the Pacific Steve Kraus highlighted the Commission’s acknowledgment that without the involvement of religious communities, the responses to HIV in the Pacific would not have been as strong as they have been.

“Within the theological bounds of their various faiths, the churches, mosques and temples have been and continue to be prominent in driving HIV Responses in the Region as powerful players in Pacific communities,” said Mr Kraus.

Mr Kraus commended the World Council of Churches Pacific member churches for their powerful and insightful 2004 Nadi Declaration on HIV and the Church. The Declaration apologises for past discrimination against people living with HIV and states that the faith community is crucial in promoting community understanding of HIV issues in the Pacific by promoting greater understanding of the fundamental messages and values of love and compassion.

Focus on Pacific countries

Pacific countries are often included in broad Asia-Pacific regional groupings where the magnitude of the problem in Asian countries overshadows the challenges and needs of smaller Pacific countries.

These realities about the regions led to the constitution of an independent Commission on AIDS in the Pacific in October 2007 to examine the current scale of the HIV epidemic in the region.

There have been 29,629 reported cases of people living with HIV in the Pacific, with 5,162 new HIV diagnoses reported in 2008.

The Commission’s Report is the first document to synthesize regional and country information on epidemiology, risks and vulnerabilities, and financing and coordination of the AIDS response. Issues of rights and civil society as well as the impact of AIDS on health are also highlighted.

Harm Reduction 2010, the 21st International conference organized by the International Harm Reduction Association is taking place in Liverpool, England from 25 – 29 April 2010. Under the theme ‘Harm Reduction: The Next Generation’, the conference has attracted around 1400 delegates from around 80 countries to share knowledge, network and promote evidence-based best practices in the field of reducing harms from drugs and alcohol.

A wide variety of participants attending include front line workers, researchers, policy makers, politicians, people from international organizations, people who use drugs and people working in criminal justice.

UNAIDS Executive Director Michel Sidibé delivered a video message at the opening ceremony where he emphasized his call to decriminalize drug users as centerpiece for an effective response to HIV.

He also underscored that in spite of the scientific evidence showing the positive results of harm reduction programmes as well as its policy and political support, there is still a long way to go.

A study recently published in The Lancet found that injecting drug users often have little or no access to evidence-informed comprehensive HIV services. Globally, only two needles and syringes are distributed to injecting drug users per month and only 8 per cent of injecting drug users receives opioid substitution therapy.

Particular attention will be paid during the conference to the growing HIV epidemic in Eastern Europe and Central Asia which is primarily being fuelled by unsafe injecting drug use. According to UNAIDS injecting drug users are those most affected by the epidemic in the region where 1.5 million people were living with HIV in 2008, a two-thirds increase from 2001 in number of new HIV infections. HIV is also spreading to the sexual partners of people who inject drugs.

After a slow start many countries in the region have made a big push for harm reduction. For example Ukraine has the highest HIV infection level in Europe and a third of injecting drug users are living with HIV. But in recent years the HIV epidemic among drug users has stabilized in the country due to a scale-up in needle and syringe exchange and, more recently, drug substitution programs.

Many studies have shown that when harm reduction services reach drug users they reduce needle sharing, and opioid substitution therapy reduces risk taking and deaths. Another large study conducted in more than 100 cities shows that where harm reduction is available, HIV infection rate reduces by nearly 19% and where it is not, it increases by 8%.

Effective harm reduction approaches include access to clean needles, opioid substitution therapy for opiate users, access to antiretroviral therapy and reducing sexual transmission of HIV from drug users to their sexual partners through condom promotion.

The 2010 Harm Reduction conference includes high profile keynote speeches, plenary sessions, symposia, workshops, training events, a film festival, poster exhibitions, exhibition areas, satellite meetings, social and networking events, and the annual IHRA award presentations. Also, a ground breaking report on the global lack of funding for HIV-related harm reduction titled 3 Cents a day is not enough was launched at the conference.

West Indies cricketer Ramnaresh Sarwan Credit: Getty Images

In conjunction with the International Cricket Council (ICC), West Indies cricketer Ramnaresh Sarwan was unveiled as a new Think Wise Champion on 26 April as part of a global cricket partnership to raise awareness of HIV.

He joins high profile cricketers Graeme Smith, Kumar Sangakkara and Virender Sehwag, as well as West Indies colleague Stafanie Taylor, in becoming a Champion for the ICC’s partnership with UNAIDS, UNICEF and the Global Media AIDS Initiative.

The global partners are also working with the Caribbean Broadcast Media Partnership on HIV/AIDS as part of the ‘Live UP’ campaign to coincide with the cricket tournament ICC World Twenty20 2010, which takes place from 30 April-16 May. This initiative encourages young people in the region to take positive action by informing themselves about the facts about HIV, getting tested and protecting themselves.

Sarwan (29) is one of the leading batsmen in the West Indies team, having made 83 Test and 154 ODI appearances to date. In that time, he has scored 15 Test centuries and four ODI hundreds to date.

“The issue of HIV is an important one for young people in the Caribbean and hopefully I can use my profile as an international cricketer to have a positive impact on people’s behavior within the region,” said Ramnaresh Sarwan.

“It is important young people are aware of resources that exist for them, such as the Live UP website, www.iliveup.com where they can find out about HIV, learn the importance of protection, and understand how to talk about these issues to their partner and friends.

“By using this event to raise awareness of HIV and remind cricket supporters not to discriminate against people with the disease, hopefully we can play our role in educating young people.”

A series of awareness activities will take place during the course of the ICC World Twenty20 2010 including community interactions between leading players and local community groups in Barbados, Guyana, St Kitts and St Lucia. The players will wear red ribbons as a show of support for people living with HIV in the semi-finals and final and public service announcements will be played on the big screen at matches.

This public service announcement, which features leading Caribbean celebrities and Stafanie Taylor is part of the Caribbean Broadcast Media Partnership’s ‘Live UP’ campaign that is being aired by 95 top broadcast media houses across 24 countries in the Caribbean.

Top Caribbean musical artists Alison Hinds, Bunji Garlin, Claudette Peters, Fay Ann Lyons and Mr Vegas, as well as Kim Collins, the St Kitts sprinter who won 100m gold at 2003 World Athletics Championships in Paris, are among those who deliver a message about HIV in a 30-second advert which has been shown across the Caribbean since last month.

The partnership between UNAIDS and ICC began in September 2003 when they first teamed up to bring messages of HIV prevention to young people across cricket playing nations. In 2006 UNICEF also joined the partnership which now also supports the “Unite for Children, Unite against AIDS” campaign.

UNAIDS Executive Director Michel Sidibé joined the President of South Africa Jacob Zuma (right)for the launch on 25 April 2010. Credit: UNAIDS/A. Vlachakis

UNAIDS Executive Director Michel Sidibé was invited by the South African government to join in the launch of a new testing campaign with President Jacob Zuma, Health Minister Aaron Motsoaledi, Premier Nomvula Mokonyane and civil society representatives Vuyiseka Dubula from the Treatment Action Campaign and Nkululeko Nxesi from the National Association of People living with AIDS.

Some 2000 people were on hand at the Natalspruit hospital in Erkuhuleni, Johannesburg. In his address at the launch, Mr Sidibé applauded President Zuma and Minister Motsoaledi for their leadership and commitment to the HIV response in South Africa, and for the unprecedented mobilization of the nation to know their HIV status.

Mr Sidibé noted: “This campaign is the biggest national mobilization in South Africa around any one single issue since the end of apartheid. Testing 15 million people by the end of 2011 is the largest programme scale-up in the world we have seen so far. It is historic.” He went on to say that South Africa was “writing a new page in the story of Africa by being the architects of the end of the HIV tragedy.”

In his statement, President Zuma disclosed his negative HIV status and encouraged South African citizens to test regularly. He stressed that the disclosure of one’s status was an individual decision and not mandatory.

The President implored the people of South Africa to change their attitudes about the epidemic and the stigma attached to HIV. He mentioned that stigma arose from ignorance, and that the benefit of the voluntary HIV Counselling and Testing campaign is its capacity to educate people about HIV and to promote the rights and dignity of people living with HIV.

The ceremony included the launch of the HIV Counselling and Testing campaign song, which was performed by Choome and Arthur Mopokane, two of South Africa’s popular singers, as well as a performance by the traditional musician Ihashi Elimhlophe.

The launch concluded with Mr Sidibé, Minster Motosaledi, Premier Mokonyane and other South African leaders testing for HIV.

South Africa’s HIV Counselling and Testing campaign is the largest HIV counselling and testing scale-up in the history of the HIV epidemic. The campaign aims to test 15 million people for HIV and to expand access to antiretroviral treatment to 80% of those in need by 2011.

South Africa has the world's largest population of people living with HIV; an estimated 5.7 million people in the country are living with HIV, representing nearly one sixth of the global disease burden. Approximately 18% of adults in South Africa are infected with HIV.

Preventing mother-to-child transmission of HIV (PMTCT) is one of the key pillars in the worldwide response to the AIDS epidemic and one of the priorities of UNAIDS Secretariat and its Cosponsors. The World Health Organization (WHO) has recently published a strategy paper outlining its commitment to support country-level and global efforts to scale up PMTCT services and to integrate such services into maternal, newborn and child health programmes.

Preventing mothers from dying and babies from becoming infected with HIV is one of UNAIDS’ key priority areas as outlined in its . The new PMTCT strategic vision 2010–2015: preventing mother-to child transmission of HIV to reach the UNGASS and Millennium Development Goals, reflects an important part of WHO’s health sector response to HIV and will contribute directly towards achieving the results of the Outcome Framework.

As a UNAIDS cosponsor which co-leads efforts to prevent mother-to-child HIV transmission within the United Nations, along with cosponsor UNICEF, WHO will use the PMTCT strategic vision to accelerate global support for prevention of mother-to-child HIV transmission.

The strategy paper urges the international community to set new, more ambitious targets that promote progress towards the virtual elimination of paediatric HIV by 2015. It also calls for greater collaboration with partners, such as the Global Fund to fight AIDS, Tuberculosis and Malaria, and the US President’s Emergency Plan for AIDS Relief (PEPFAR).

Significant progress in PMTCT has occurred in recent years and in 2008 around 45% of pregnant women living with HIV in low- and middle-income countries received antiretroviral drugs to prevent mother-to-child transmission of HIV. This is in contrast to only 10% in 2004.

Despite these successes, coverage levels of PMTCT services are still low in a number of resource-limited countries and communities. According to the UNAIDS/WHO AIDS Epidemic Update 2009 an estimated 430,000 children were newly infected with the virus in 2008, more than 90% of them through vertical transmission from their mothers. Without treatment, around half of these children will die before their second birthday.

But mother-to-child transmission is almost entirely preventable where services are accessible, and PMTCT interventions can reduce the risk of infection to less than 5%.

The PMTCT strategic vision can help address this by promoting a comprehensive approach that includes the following four components: primary prevention of HIV infection among women of childbearing age; preventing unintended pregnancies among women living with HIV; preventing transmission from an HIV-positive woman to her infant; and providing appropriate treatment, care and support to mothers living with HIV and their children and families.

The new document highlights a series of needed strategic directions:

• Strengthen commitment and leadership to achieve full coverage of PMTCT services
• Provide technical guidance to optimize HIV services for women and children
• Promote and support integration of HIV interventions within maternal, newborn and child health and reproductive health programmes
• Ensure equitable access for all women, including the most vulnerable
• Support health systems interventions to improve service delivery
• Track programme performance and impact
• Strengthen global, regional and country partnerships and advocate for increased resources.

The publication provides a number of country and regional examples. In Asia, several nations have begun linking HIV services with reproductive, adolescent, maternal, newborn and child health services.

Along the same lines, the elimination of mother-to-child transmission of HIV and congenital syphilis in Latin America and the Caribbean (affecting some 6,000 children and 450, 000 pregnancies each year respectively) has been defined as a top priority by the WHO Regional Office for the Americas and UNICEF. Together with partners, they have recently launched a campaign with the objective to eliminate mother-to-child transmission of HIV by 2015.

The PMTCT strategic vision also shows that interventions needed vary depending on country or regional circumstances. In Eastern Europe, for instance, emphasis is not on general population interventions but on improving PMTCT services for key populations at higher risk such as injecting drug users and their partners.

It is clear that whatever the context, the need to eliminate mother-to-child transmission of HIV is of paramount necessity. The PMTCT strategic vision is designed to be a key tool to strengthen WHO's support to this global effort to save lives and protect the health of the world’s women and children.

During an official visit to Senegal, the UNAIDS Executive Director Michel Sidibé (left) was received by the President, Mr Abdoulaye Wade on 19 April.

During an official visit to Senegal, the UNAIDS Executive Director was received by the President, Mr Abdoulaye Wade on 19 April. Mr Sidibé thanked President Wade for taking the initiative to include an important item on the agenda of the African Union Summit in July 2010 in Kampala, Uganda, titled “Accelerating measures on HIV and MDGs: Partnership to Eliminate Mother-to-Child Transmission of HIV in Africa.” The Executive Director noted that HIV has been the major cause of child and infant mortality in major parts of Africa, with about 390,000 children under 15 newly infected with HIV in 2008 alone.

Mr Sidibé also thanked President Wade for the successes recorded by his country in the fight against HIV in general and in the eradication of vertical transmission from mother to child in particular.

In response, President Wade assured Mr Sidibé that “Senegal will work with UNAIDS towards the goal of zero new infections in Senegalese children by 2015.”

Mr Michel Sidibé was in Dakar, Senegal, to take part in the UNAIDS Sub-Saharan Africa Regional Management Meeting, with the aim of leveraging HIV for broader health and development outcomes in Africa and to discuss Senegal’s progress on universal access with its authorities.

UNAIDS Executive Director Michel Sidibé (right) also met the Prime Minister of Senegal, Mr Souleymane Ndéné Ndiaye, who reaffirmed Senegal’s commitment to total eradication of mother-to-child transmission.

Mr Sidibé also met the Prime Minister of Senegal, Mr Souleymane Ndéné Ndiaye, who reaffirmed Senegal’s commitment to total eradication of mother-to-child transmission. He said that “the prevention of new infections should be a priority for all African countries.”

During his visit, Mr Sidibé noted that a lot of progress had been made in the AIDS response in Africa. “In 2008, about 45% of pregnant women living with HIV in this region were receiving antiretroviral drugs to prevent transmission to their children, up from 35% the previous year. Tens of thousands of new HIV infections have been prevented as a result of prevention programmes and the efforts of African governments, civil society and youth,” said Mr Sidibé. Yet despite progress, many challenges remain that prevent people from accessing the HIV prevention and treatment services they need, he added.

To help successfully implement the project and build the capacity of NGO staff and government officials, five days of training in HIV took place in Kabul.
Credit: UNODC

Providing comprehensive HIV services for injecting drug users is critical to an effective HIV response. In recognition of this, the United Nations Office on Drugs and Crime (UNODC) has begun to support the implementation of an initiative to make services accessible to Afghan refugees who inject drugs in Iran and Pakistan, and also to Afghan injecting drug users who have returned home.

The use of non-sterile injecting drug equipment is one of the most efficient modes of HIV transmission and remains one of the critical activities fuelling HIV epidemics among drug users. HIV can also spread from people who inject drugs to their sexual partners and other populations at higher risk of HIV exposure such as sex workers.

The project aims to create an environment that supports a cross-border regional network of HIV services so that Afghan refugees will be able to access HIV services when they go back to their country. UNODC awarded two grants to non-governmental organizations to provide services to Afghan drug users in Herat province, bordering Iran and Nangarhar, which borders Pakistan.

Khatiz Organization for Rehabilitation in Herat and the Health and Social Development Organisation in Nangarhar are using mobile outreach units to offer a wide-ranging set of servcies. These include facilitating specific information and education materials for drug users; distributing clean needles and syringes; promoting and distributing condoms; treating and helping prevent sexually transmitted infections; primary healthcare such as HIV voluntary counseling and testing services and antiretroviral treatment.

Training in HIV and drug use 

To help successfully implement the project and build the capacity of NGO staff and government officials, five days of training in HIV took place in Kabul. Doctors, nurses, social workers, project managers and employees from the women’s prison participated.

During the meeting, also attended by high-level delegations from the government, UN agencies and NGOs, the seriousness of the situation in Afghanistan was discussed. Dr.Mohammad Zafar, Deputy Minister of Counternarcotics, told the gathering that according to a 2005 UNODC survey, the country has one million drug users, including 19 000 – 25 000 who inject drugs, making up 3.8% of the total population.

According to Dr.Ajmal Sabaoon, National AIDS Control Programme Manager, Afghanistan is moving from a low-level HIV epidemic towards a concentrated epidemic. He briefed participants on results of an Integrated Biological and Behavioral Survey conducted by John Hopkins University in 2009, which indicates that HIV prevalence among injecting drug users in three major cities of the country (Kabul, Herat and Mazar) has increased from 3% to 7% from 2007 to 2010.

Knowledge of HIV among IDUs is also very low. According to the study, only 29 % of the IDUs could correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission. About 22 % of the IDUs have ever tested and know their HIV status.

The surveyed injecting drug users are known to be mobile, as almost 80% reported that they had changed residence at least once. Much of the mobility appears to be related to various phases of the conflict in the country, with the majority of IDUs relocating to Pakistan or Iran. The UNODC and its partners hope that by providing HIV services to injecting drug users in such bordering locations will help reverse the growing HIV prevalence among IDU in the country as well as within the sub regional area.

Protecting drug users against HIV is one of the nine priority areas in the UNAIDS Outcome Framework 2009-11. This can be aided by making comprehensive, evidence-informed and human-rights-based interventions, such as harm reduction and demand reduction, accessible to all who need them.

A new report published in the medical journal The Lancet found that, for the first time in decades, the number of women dying each year from pregnancy and childbirth has significantly drop. Credit:UNAIDS/P.Virot

A new report published in the medical journal The Lancet found that, for the first time in decades, the number of women dying each year from pregnancy and childbirth has significantly dropped. Researchers estimate that maternal deaths fell from 526 300 in 1980 to 343 900 in 2008.

UNAIDS Executive Director Michel Sidibé has welcomed the findings of the new report while attending the Launch Meeting of the Secretary-General’s Joint Effort on Women’s and Children’s Health. The two-day meeting brings global health leaders together to generate consensus as well as to plan measures to achieve the Millennium Development Goals 4 and 5.

The report, carried out by the University of Washington and the University of Queensland and funded by the Bill & Melinda Gates Foundation, highlights that progress in reducing maternal mortality has been slowed by the ongoing HIV epidemic. Nearly one out of every five maternal deaths— a total of 61,400 in 2008—can be linked to HIV, and many countries with large populations affected by HIV have had the most difficulty reducing their maternal mortality ratio. In South Africa, more than 50% of all maternal deaths are linked to HIV.

“This study serves as a powerful reminder that progress in maternal health efforts is hugely dependent on progress in the AIDS response in countries with the most severe HIV epidemics,” said Mr Sidibé.

Mr Sidibe emphasized the UNAIDS pledge to continued support for the virtual elimination of mother-to-child transmission as outlined in its Outcome Framework 2009 - 2011. He also highlighted UNAIDS' commitment to ensure women living with HIV have access to treatment before and after birth to guarantee that newborn babies are not infected with HIV and mothers stay healthy.

Evidence shows that timely administration of antiretroviral drugs to HIV-positive pregnant women significantly reduces the risk of HIV transmission to their babies; it is a proven, inexpensive, and effective intervention. However, at the end of 2008, only 45% of HIV-positive pregnant women received the necessary treatment in low- and middle-income countries. Progress in this area can only be achieved by improving the quality of data and by integrating programmes which prevent the transmission of HIV from mothers to their children into the broader reproductive health agenda.

A version of the story was first published at unicef.org

Ann M. Veneman visits clients at a children's clinical centre built by Baylor College of Medicine and Bristol-Myers Squibb in Maseru, Lesotho, where paediatric and family HIV care and treatment services are provided to young children and their caregivers.

During a recent visit to Lesotho, UNICEF Executive Director Ann M. Veneman launched Facts for Life, a publication that delivers life-saving information to families and communities on how to prevent child and maternal deaths, diseases, injuries and violence.

“Education is key”, said Ms Veneman. “Through simple messages, Facts for Life aims to bring vital knowledge to parents and caregivers, who are the first line of defence in protecting children from illness and harm.”

Circulated worldwide

Some 15 million copies Facts for Life have reached billions of people since its first publication in 1989. It is a co-publication by UNICEF, WHO, WFP, UNESCO, UNFPA, UNDP, UNAIDS and the World Bank, and provides practical advice on pregnancy, childbirth, major childhood illnesses, child development, early learning, parenting, protection, care and support for children.

New chapter on child protection

The publication includes a chapter on managing HIV. It promotes early diagnosis in children, effective treatment and anti retroviral therapy when prescribed. Currently most HIV-positive children are given such treatment after the age of five, when it might be too late. Without treatment, half of all babies born with HIV will die before their second birthday.

“One in ten children in Lesotho does not survive to see his/her fifth birthday, most as a result of AIDS and preventable causes like pneumonia and diarrhea, exacerbated by malnutrition” said Ms. Veneman, “Facts for Life can help bridge the information gap that contributes to the needless death of millions of young children.”

The publication also contains a new chapter on child protection, which provides information on keeping children safe from violent and harmful behaviours and practices.

“Girls and boys must be protected from violence and abuse,” said the Executive Director. “Protecting children so that they can grow up in safe environments and reach their full potential can help break the cycle of poverty.”

Functioning ARV dispensing site in Port-au-Prince after the devastating 12 of January earthquake. Credit: UNAIDS

Haitian civil society representatives visited Washington, D.C. on 6 April to mobilize political support for reconstructing the AIDS response in Haiti.

The civil society delegation, with support from UNAIDS, gave a testimony of their experiences with the earthquake and highlighted the importance of reconstructing the AIDS response with direct involvement of affected communities, especially people living with HIV. The briefing was held at Capitol Hill during a US Congressional briefing sponsored by US Senator Kirsten Gillibrand (D-NY) and attended by congressional staff, AIDS advocates and US civil society representatives.

Later that same day, the delegation from Haiti visited US Global AIDS Coordinator Ambassador Eric Goosby and his colleagues from USAID. The US government team pledged its support to encourage the Haitian government to include the involvement of people living with HIV in planning the reconstruction of the AIDS response in Haiti.

On 24 March, US President Obama asked the US Congress to approve $2.8 billion as an emergency requirement for relief and reconstruction support for Haiti following the devastating earthquake of 12 January 2010. The request is now pending before US lawmakers who will very soon vote on the proposal.

There were an estimated 120 000 people living with HIV in Haiti before the earthquake. Most of the structural damage happened in the three departments (Ouest, Sud-Est and les Nippes) that accounted for nearly 60% of the population of people living with HIV.

Following an initial rapid assessment of the situation with the Ministry of Public Health and Population, UNAIDS released a concept note Helping Haiti rebuild its AIDS response. The report explains the current situation in Haiti and what may be required to meet the immediate and intermediate AIDS response needs.

Civil society networks of people living with HIV as well as many of the organizations providing HIV services have been affected by the earthquake and are in need to be strengthened.