Rev. Gunnar Stålsett, Bishop Emeritus of the Church of Norway (right) with His Holiness Abune Paulos signing the personal commitment to action at the Summit of High Level Religious Leaders on the Response to HIV. 22-23 March, The Netherlands.
Credit: UNAIDS

A Summit of High Level Religious Leaders on the Response to HIV took place in The Netherlands from 22 to 23 March. The meeting explored opportunities for religious leaders to promote universal access to HIV prevention, treatment, care and support in their communities and speak out against stigma and discrimination affecting people living with HIV. It brought together some 40 Baha’í, Buddhist, Christian, Hindu, Jewish, Muslim and Sikh leaders together with the Executive Directors of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Population Fund (UNFPA), the AIDS Ambassadors of The Netherlands and Sweden, leaders and representatives of networks of people living with HIV and other organizations active in the response to HIV.

Speaking at the opening ceremony, UNAIDS Executive Director Michel Sidibé said, "As I travel the world, I see increasing evidence of social injustice. Growing economic disparities, inequality and social injustice stalk the earth. The greatest impact is felt by the poorest segments of society, on women and girls and on the marginalized. Social injustice only serves to increase the vulnerability of the vulnerable and push them farther out of reach of HIV services. I sincerely hope that this meeting will produce a call for action to make these services available and virtually eliminate mother to child transmission of HIV. Nothing would be more noble than a world with no more babies born with HIV."

During the Summit, participants addressed the realities of how stigma and discrimination are perpetuated both in religious communities and society at large. They identified best practices to strengthen the voice and action of religious leaders and bring about collaboration among different faiths and with other sectors involved in the response to HIV.

“The leaders gathered at this summit have the ability to inspire and empower change – within their own communities, across countries, and throughout wider communities,” said Rev. Dr. Richard Fee, Chair of the Board of Directors of the Ecumenical Advocacy Alliance and General Secretary, Life and Mission Agency, Presbyterian Church in Canada. “In the midst of what appears to be ‘AIDS fatigue” they have the potential to galvanize efforts against a disease that continues to spread, driven by silence, fear, violence and injustice.”

Since the beginning of the HIV epidemic, religious communities, mosques, temples, churches, hospitals and clinics have reached out to provide support to those living with and affected by HIV. Strengthening their leadership can greatly influence the lives of many people, and leaders speaking out responsibly about AIDS can make a powerful impact at both community and international level.

"Participants affirmed in their concluding statement the "renewed sense of urgency" to prioritize and strengthen the response to HIV. Such response includes "holistic prevention" in addition to reaching universal access to treatment, care and support. The statement called for the "Universal respect for the human rights of all people living with and affected by and at risk of HIV infection" and the "respect for the dignity of every human being". Leaders also called for "a massive social mobilization" to support services for women to eliminate the transmission of HIV from mother to child.

In addition, religious leaders drafted and personally signed a pledge to commit themselves to strengthened efforts to respond to HIV. The pledge includes "deepening meaningful engagement with people living with HIV" and "acting decisively to protect human rights within my faith community; through collaboration among other religious leaders of different faiths; and by influencing local, national, regional and global decision-making processes on HIV."

Dr Thoraya Ahmed Obaid, Executive Director of UNFPA, in her closing remarks said, "Our work together proves that interventions can be successful and sustainable if change is inclusive, if it emerges from within the faith and cultures of the people themselves, if people of all age groups living with (or without) HIV are secure in their sense of belonging and are fully engaged, and all partners are equally valued and respected."

The co-chairs of the event were His Holiness Sri Sri Ravi Shankar, Founder of the Art of Living Foundation; Rabbi David Rosen, Director of Interreligious Affairs of the American Jewish Committee; Ms. Nyaradzayi Gumbonzvanda, General Secretary of the World YWCA; and the Right Rev. Gunnar Stålsett, Bishop Emeritus of the Church of Norway.

The Summit was organized by the Ecumenical Advocacy Alliance and Cordaid, with support from the Dutch Ministry of Foreign Affairs, UNAIDS, International Network of Religious Leaders Living with or Personally Affected by HIV or AIDS (INERELA+), the World AIDS Campaign and the European Council of Religious Leaders (Religions for Peace).

Courtesy of the World Bank

For many in West Africa, the road network is a vital socio-economic lifeline but it can also be a way for the spread of HIV. An ambitious programme, the World Bank Abidjan-Lagos Transport Corridor (ALCO) project, has seen marked success in helping people living and working along this highway to reduce their vulnerability to HIV. ALCO’s results, opportunities and challenges are analyzed in a recent World Bank report, part of its HIV/AIDS in Africa: Getting Results series.

The report highlights that HIV prevalence in the transport sector is higher than in the general population, and with some 14 million people travelling along the 1,000 kilometre corridor each year, need for an effective intervention was clear.

The ALCO project, set up in 2004 and sustained since 2007 by a grant from the Global Fund, identified some of the circumstances on the road stretching from Cote d’Ivoire to Nigeria conducive to high risk behaviour. For example, many truck drivers and other mobile workers spend large amounts of time away from their families and often have multiple partners. These include sex workers and others living along the highway and around truck stops.

The aim of the project was to provide HIV prevention services to people in these areas such as truck drivers, sex workers, travellers, border communities and military and customs officials.

Project plan

Multiple partners participated in the project, including national and local government and the health and transport sectors. Stakeholders were brought together on a number of levels and often with distinct concerns and priorities. 87 implementing agencies were engaged in total, with the World Bank offering targeted technical support. UNAIDS, according to the report, provided technical and financial support and was crucial in bringing the project to completion.

The programme had three facets. The first one involved HIV prevention and concentrated on behaviour change, increase HIV awareness and condom distribution. In three and a half years, more than 600 condom sales points were set up along the route and nearly nine million condoms distributed.

The second component, care and support, included providing voluntary HIV counselling and testing, community based care, diagnosis of opportunistic and sexually transmitted infections and antiretroviral treatment.

The final aspect involved inter-country coordination, training and policies to maximise the benefits of working across borders on a regional project, and reduce the long waits at border crossings.

Results

Several lessons were learned, such as the importance of the strong participation of HIV-positive people: the West African Network of People Living with HIV/AIDS was a key partner. According to the project’s managers, the integral involvement of PLHIV and the sense of their ownership of the project helped to make it a success. There was also a harmonised, cross-border, evidence-based communications strategy which provided consistent messaging, emphasised community participation and engaging gatekeepers, built communications capacity in both traditional and non-traditional service providers and paid specific attention to gender issues.

By the end of the project’s first phase, some 28,000 people along the corridor had accessed voluntary HIV counselling and testing services and nearly 1,500 border town residents had been trained as key community AIDS information, education and communications activists.

HIV prevention knowledge increased dramatically in the target populations, from 50-68% to 83-88%. Condom use at last encounter increased significantly, and prevalence of other sexually transmitted infections among sex workers fell markedly. Other knock-on effects have included an increased commitment to workplace AIDS programmes in the transport sector.

Challenges

The project has not been without challenges. From programme materials to systems and the forging of new partnerships had to be set up from scratch. Building grassroots capacity was described in the report as difficult and costly. The cross-border nature of the project also required a huge effort in coordination, time and diplomacy, with a need to work in both English and French and an array of local languages.

However, the Corridor project has made a real and measurable difference in HIV-related knowledge and behaviour amongst people living along West Africa’s Abidjan to Lagos transport route. The five year follow-on grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria is making it possible to sustain this success.

According to the report, “Perhaps the most important contributions of the Abidjan- Lagos Corridor Project have been bringing HIV prevention programmes to very hard-to-reach and vulnerable people and establishing a platform for regional integration beyond AIDS and transportation.”

For the first time, the WHO global report includes an assessment of progress countries are making in the diagnosis and treatment of multidrug-resistant TB.

Up to a quarter of people with tuberculosis in some regions can no longer be treated with standard drug regimens. This is the stark finding of a new World Health Organization report which estimates that 440,000 people had multidrug-resistant TB (MDR-TB) in 2008, a third of whom died.

Multidrug and Extensively Drug-Resistant Tuberculosis (M/XDR-TB): 2010 Global Report on Surveillance and Response presents data from 114 countries. It underlines that almost half of all cases of MDR-TB are estimated to occur in China and India. In Africa an estimated 69,000 cases emerged.

The report also explores the relationship between HIV and MDR-TB and notes that drug resistant TB among people living with HIV has been widely documented in certain settings, such as hospitals. It further states that TB patients co-infected with HIV in three Eastern European countries, Estonia, Latvia, and the Republic of Moldova, were found to be at greater risk of having multidrug-resistant tuberculosis compared to TB patients without HIV infection.  Studies in Lithuania, Ukraine and Mozambique show similar results. More research is required to ascertain whether these findings would be replicated worldwide and the report notes that no data have been received from countries with the highest HIV prevalence.

According to UNAIDS, HIV-positive people are especially vulnerable to the impact of TB and MDR-TB. They are at increased risk of contracting the disease and experiencing serious side effects and are more likely to die if infected. HIV and TB are seen as so closely connected that they are often referred to as ‘co-epidemics’. To appropriately respond to both epidemics and avoid more widespread drug resistance, fully integrated TB/HIV services should be priority concern of all TB and HIV programmes.

Preventing people living with HIV dying from tuberculosis is one of the nine priority areas in the UNAIDS Outcome Framework 2009-11. 

According to the WHO report only an estimated 7% of all MDR-TB patients are diagnosed. Credit: WHO/D.Orr

For the first time, the WHO global report includes an assessment of progress countries are making in the diagnosis and treatment of multidrug-resistant TB. Six countries are the subject of special focus. Bangladesh is one of the few developing nations carrying out continuous surveillance among TB cases which were previously treated in selected areas. China has reported results from its first ever drug resistance survey; Ethiopia was among the first countries to introduce rapid molecular laboratory tests. Nepal and Romania both have successful treatment programmes for MDR-TB and South Africa has introduced policy changes for improving management and care for those living with the disease.

Although there has been notable success in some countries, world-wide progress in controlling multidrug-resistant TB remains slow. According to the WHO report only an estimated 7% of all MDR-TB patients are diagnosed.

Of major concern is the very high cost of treating this form of the disease. The price of drugs alone is 50 to 200 times higher than treating a drug-susceptible TB patient. However, WHO maintains that treatment of MDR-TB has been shown to be cost-effective.

According to the report, there is an urgent need for drug regimens which are shorter than the current two year span, improvements in laboratory facilities and access to rapid diagnosis and treatment. WHO is undertaking a five-year project aimed at strengthening TB laboratories with rapid tests in some 30 countries. It is also working closely with a number of organisations to increase access to treatment so that more lives can be saved.

Note: Multi-drug resistant TB (MDR-TB) is tuberculosis that is resistant to at least Rifampicin and Isoniazid, the two most powerful anti-tuberculosis drugs. Extensively drug- resistant TB (XDR-TB) is MDR-TB that is also resistant to at least two out of the three classes of second line TB medicines.

New data analysis released on 10 March by the United States Centers for Disease Control and Prevention (CDC) highlights that HIV and syphilis disproportionately impact men who have sex with men in the United States (U.S.).

New data analysis released on 10 March by the United States Centers for Disease Control and Prevention (CDC) highlights that HIV and syphilis disproportionately impact men who have sex with men in the United States (U.S.).
The data, presented at CDC's 2010 National STD Prevention Conference, found that the rate of new HIV diagnoses among men who have sex with men (MSM) in the U.S. is more than 44 times that of other men and more than 40 times that of women.

"While the heavy toll of HIV and syphilis among gay and bisexual men has been long recognized, this analysis shows just how stark the health disparities are between this and other populations," said Kevin Fenton, M.D., Director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "It is clear that we will not be able to stop the U.S. HIV epidemic until every affected community, along with health officials nationwide, prioritize the needs of gay and bisexual men with HIV prevention efforts."

According to CDC many aspects contribute to the high rates of HIV and syphilis among gay and bisexual men in this country. Homophobia and stigma can prevent MSM from seeking prevention, HIV testing and counselling, and treatment services. Other causes include limited access to prevention services, unsafe sex practices and complacency about HIV risk due to existence of treatment, particularly among young gay and bisexual men.  Also, the risk of HIV transmission through anal sex is much greater than the risk of transmission via other sexual activities.

''It seems like we have come full circle in the United States,'' said UNAIDS Executive Director Michel Sidibé. ''Efforts must be redoubled to include gay and bisexual men in AIDS programming and reach out to and address the HIV prevention needs of all men who have sex with men.'' 
Prevention programmes

According to UNAIDS, HIV prevention measures for men who have sex with men should include consistent and proper use of condoms, and access to water-based lubricants. High quality HIV-related services, like voluntary counseling and testing in a non-discriminatory environment,, should be made available as well as specific and targeted information on prevention and risk reduction strategies designed to appeal to and meet the needs of men who have sex with men. Further quality treatment for sexually transmitted infections with referral for HIV services must be made available.

The U.S. Department of Health and Human Services notes that in the United States men as a whole, are less likely to use the health care system than women. Men often seek care when they are experiencing critical health problems. Men who have sex with men who do not access health care may not know they are infected with HIV or an STD, thus compromising their own health status. The persistence of stigma and homophobia compounds the situation still further.

CDC officials noted that the new analysis underscores the importance of the HIV and STD prevention efforts to reach gay and bisexual men recently announced as part of the U.S. President's fiscal year 2011 national budget proposal.

The new analysis is the first step in more fully assessing the extent of HIV among MSM and other populations in the United States. The CDC is developing more detailed estimates of infection rates among MSM by race and age, as well as among injection drug users. Ultimately, these data can be used to better inform national and local approaches to HIV and STD prevention to ensure that efforts are reaching the populations in greatest need.

UNAIDS Executive Director, Mr Michel Sidibé and CPLP Executive Secretary, Mr Domingos Simões Pereira signing the cooperation agreement. 17 March 2010, Lisbon, Portugal.

The Community of Portuguese-Speaking Counties (CPLP) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) formalized their cooperation in response to AIDS in CPLP countries with a Memorandum of Understanding. The cooperation agreement was signed today by CPLP Executive Secretary, Mr Domingos Simões Pereira and by UNAIDS Executive Director, Mr Michel Sidibé.

“This agreement strengthens the cooperation that has existed for several years between CPLP and UNAIDS. We are particularly committed to promoting the human rights of people living with HIV and to preventing infection in those countries where Portuguese is the official language,” stated CPLP Executive Secretary, Domingos Simões Pereira.

The Memorandum of Understanding seeks to mobilize technical, political and financial support for civil society networks and organizations, including people living with HIV in the Portuguese-speaking countries. It aims to develop channels for sharing experiences between these countries, by means of horizontal South-South technical cooperation.

“South-South cooperation among Portuguese-speaking nations can help achieve universal access to HIV prevention treatment, care and support and eliminate mother to child transmission of HIV,” said Mr Sidibé.  “We can learn from each other, especially when we share a common vision in changing the course of the AIDS epidemic.”

The cooperation agreement forms part of the activities of the III CPLP Congress on HIV/AIDS and Sexually Transmitted Diseases, which is being held in Lisbon, Portugal from March 17-19.

Although the Caribbean as a region has the second highest HIV prevalence after sub-Saharan Africa, most countries have concentrated epidemics which disproportionately affect certain groups including gay men and other men who have sex with men (MSM). In many countries men who have sex with men experience considerable social stigma and are not reached with vital HIV prevention, treatment, care and support services. Not only are men afraid of disclosing their sexual activity, they are also deterred from finding out what they need to know to reduce their risk or to buy condoms.

An environment of homophobia is often reinforced by anti-sodomy legislation which exists in 11 of 16 Caribbean countries*. This can contribute to an intolerant cultural and social environment which risks keeping men who have sex with men away from accessing HIV testing and counselling and education services that would reduce the vulnerability to HIV infection.

In Jamaica—a country with anti-sodomy laws—there is 32% HIV prevalence among MSM, versus 1.6% in the general population. In Trinidad & Tobago and Guyana, countries which also criminalize sex between men, the HIV prevalence ranges from 20% to 32%. While in Cuba, Suriname, the Bahamas, Dominican Republic, countries without such legislation, the HIV prevalence in MSM ranges from 1% to 8%.

According to 2007 UNGASS Country Progress reports less than 40% of MSM in the Caribbean are reached by prevention programmes. Local groups in many countries in the Caribbean have been urging civil society and government programmes to include MSM issues and organizations within the AIDS response. These efforts have been supported by regional networks including PANCAP.

UNAIDS Executive Director Michel Sidibé has called for an end to punitive laws which hamper the AIDS response in this region.

“In most of the countries in the Caribbean that don't have repressive laws, HIV prevalence is between 1% and 8% among men who have sex with men,” said UNAIDS Executive Director Michel Sidibé. “This contrasts sharply with a range of between 20% and 32% in countries which outlaw sex between men.”

“Reducing homophobia and removing punitive laws that criminalize sex between men creates the right conditions for achieving universal access,” Mr Sidibé continued.

A collaborative effort is underway between UNAIDS, UNDP and PAHO/WHO to develop strategies for Latin America and the Caribbean on human rights and improvement of access to health services for MSM and other sexual minorities.

UNAIDS will lead a regional effort in the Caribbean to strengthen HIV prevention programmes among these groups, to bring together the human rights and service provision components for their improved health, human rights and well-being.


* Countries in the Caribbean with laws that criminalize men who have sex with men: Antigua and Barbuda, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago. Countries in the Caribbean with no laws criminalizing men who have sex with men: Bahamas, Cuba, Dominican Republic, Haiti, Suriname. According to ILGA web site accessed 16 March 2010

UNAIDS Executive Director, Michel Sidibé and John Tedstrom, President & CEO of GBC. 15 March 2010, New York . Credit: UNAIDS

On 15 March 2010, UNAIDS Executive Director, Michel Sidibé met with more than 15 private sector companies affiliated with the Global Business Coalition on AIDS, Tuberculosis and Malaria (GBC). Mr Sidibé highlighted UNAIDS’ priorities for 2010-11 and reiterated his call for the virtual elimination of mother-to-child transmission by 2015.

Across the world, each year more than a million pregnant women risk passing along HIV to their child. In 2008, approximately 45% of pregnant women known to be living with HIV received antiretroviral drugs to prevent HIV transmission to their children.

“Ending mother-to-child transmission is everyone’s business and I urge the private sector to leverage their core competencies, resources and advocacy muscle to prevent all babies from becoming infected with HIV” said Mr Sidibé.

The impact of AIDS on the labour force impacts both the public and private sectors. The epidemic is eroding productivity at a time developing countries need to become more competitive to cope with rapid globalization. In the private sector, this raises the costs of doing business and deters investment.

The virtual elimination of mother-to-child transmission would tackle one of the three ways of transmission of HIV (sexual, blood related and vertical). It also represents a positive difference on the health of women and children contributing to Millennium Development Goals 4, 5 and 6. Above all, it is doable in a business time frame i.e. by 2012 in the 13 highest burden countries and globally by 2015.

UNAIDS is convinced that mother-to-child transmission is an issue that the private sector can effectively tackle. The private sector has core competencies which can be of use: financial and accounting skills, technical know-how, understanding of communications products, marketing and selling of products and services, and valuable knowledge to reach and change opinions and behaviours of large number of people.

More than 15 private sector companies affiliated with the Global Business Coalition on AIDS, Tuberculosis and Malaria (GBC) participated in the meeting to explore effective collaboration with UNAIDS to achieve virtual elimination of mother-to-child transmission. Credit: UNAIDS

The meeting included companies such as Abbott, BD, Boehringer Ingelheim, Bristol-Myers Squibb, Booz & Co., Colgate-Palmolive, Johnson & Johnson, Mylan, the National Basketball Association, OraSure, Pfizer, Premier Medical Corporation, Spike DDB, Standard Bank, Standard Chartered Bank, Unilever and Vestergaard.

“As we move into an era which is shaped by new and unexpected resource challenges and which prioritizes more sustainable responses to HIV and other global health challenges, it is more important than ever that we are all part of a unified team,” said John Tedstrom, President & CEO of GBC. “Our partnership with UNAIDS generally and our joint commitment to combating mother-to-child transmission of HIV expressed in today's meeting is part of the Coalition's effort to ensure alignment on all our global health priorities.”

Several international companies have made public and global commitments in support of virtual elimination of Mother-to-Child Transmission of HIV. Johnson & Johnson in South Africa, Bristol-Myers Squibb, Bayer College of Medicine in Africa, Boeringer’s Viramune donation programme to developing countries, and Chevron in Angola.

The meeting laid an effective platform to develop a follow-up plan for the development of public-private partnerships in order to strengthen the AIDS response. Over the next 24 months, UNAIDS, GBC and their partners will intensify efforts to save mothers and babies as an achievable and inspirational step toward helping countries achieve their universal access goals to HIV prevention, treatment, care and support.

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

UNAIDS Executive Director Michel Sidibé at a press conference held March 10 to discuss AIDS 2010.

The rapidly growing AIDS epidemic in Eastern Europe, fuelled primarily by unsafe injecting drug use, will be a key focus of the XVIII International AIDS Conference (AIDS 2010), to be held in Vienna in July.

"To break the trajectory of the HIV epidemic in Eastern Europe, we must stop new infections among injecting drug users and their partners," said UNAIDS Executive Director Michel Sidibé at a press conference held March 10 to discuss AIDS 2010. "People using drugs have a right to access the best possible options for HIV prevention, care and treatment."

The United Nations, through the Joint United Nations Programme on HIV/AIDS (UNAIDS) and UNODC, is supporting the AIDS 2010 conference, to be held from 18 to 23 July 2010, which is organized by the International AIDS Society, a non-governmental organization.

Around 25,000 people working in the field of HIV, including policymakers, legislators, researchers, people living with HIV and others committed to working on AIDS issues will attend the conference, whose theme, Rights Here, Right Now, emphasizes the central importance of human rights in responding to HIV.

By holding the conference in Vienna, the organizers will highlight the situation in Eastern Europe and Central Asia, regions experiencing a fast growing epidemic largely through unsafe injecting drug use. An estimated 1.5 million people are living with HIV in these regions. Sharing needles and injection equipment is thought to be three times more likely to transmit HIV than sexual intercourse.

"We can and must reverse the HIV epidemic, first of all by preventing the spread of drug use, and then by providing treatment to addicts. In this comprehensive programme, HIV-targeted measures include providing clean injecting equipment, opioid substitution and antiretroviral therapy," said UNODC Executive Director Antonio Maria Costa.

Life on the edge

Yet, as the results published last week in The Lancet show, 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 receive opioid substitution therapy (Mathers et al, 2010).

UNODC Executive Director Antonio Maria Costa speaking at a press conference held March 10 to discuss AIDS 2010.

Many of today’s drug users live a life on the margins of society: they can be arrested, even for possessing a clean needle, and sent to prison, where the perfect environment is created for HIV and TB to spread. Or they can be confined to compulsory drug detention centres, often with no due legal process, where they are shackled and beaten in the name of drug “treatment” but with no access to any medically supervised remedies for drug dependency.

“We must focus our efforts to create evidence-based harm reduction measures that work, helping drug users protect their health and the health of the broader community—including preventing HIV infection,” said Mr Sidibé during his intervention at the 53rd session of the Commission on Narcotic Drugs. “Harm reduction is an effective and important form of HIV prevention and a key component of our pledge for universal access to HIV prevention, treatment, care and support”.

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.

UN Secretary-General Ban Ki-moon has called on Member States to ensure that people who are struggling with drug addiction be given equal access to health and social services, and asserted, “No one should be stigmatized or discriminated against because of their dependence on drugs.”

UNODC is the lead agency within UNAIDS for HIV prevention, treatment, care and support for injecting drug users and in prison settings. It works in 55 priority countries in Africa, Eastern Europe and Central Asia, South and South-East Asia, Latin America and the Caribbean, helping countries to provide drug users, prisoners and people vulnerable to human trafficking with comprehensive evidence-informed HIV services.

UNAIDS Executive Director Michel Sidibé met with UN Human Rights Council President Ambassador Martin Uhomoibhi on 11 March 2009 at UNAIDS Secretariat, Geneva.
Credit: UNAIDS

UNAIDS Executive Director Michel Sidibé met with UN Human Rights Council President Ambassador Martin Uhomoibhi on 11 March. The Tenth Session of the Human Rights Council is currently taking place in Geneva.

A progress report from the United Nations Secretary-General on HIV and human rights has been submitted to the Tenth Session of the Human Rights Council which is taking place in Geneva from 2-27 March 2009.

The report notes some advances in recent years, but it also underlines that “a number of human rights challenges remain, which pose barriers to achieving universal access to HIV prevention, treatment, care and support.” These include stigma and discrimination; legal and policy barriers to accessing HIV-related services, including harm reduction services; and human rights violations against women and girls, men who have sex with men, sex workers, people who use drugs, and prisoners.

UNAIDS Executive Director meets UN Human Rights Council President

UNAIDS Executive Director Michel Sidibé hosted a meeting with UN Human Rights Council President Ambassador Martin Uhomoibhi on 11 March. They discussed the importance of raising the profile of HIV in the work of the Council, and mobilising leadership to address difficult human rights issues that stand in the way of universal access to prevention, treatment, care and support.

The UNAIDS Executive Director spoke of the vital importance of paying attention to human rights to protect the most vulnerable in the AIDS epidemic.

Mr Sidibé added that communities and individuals most affected by AIDS have to remain at the centre of all efforts – locally, nationally and globally and that civil society must be supported to stand by those most affected and amplify their voice.

UNAIDS Statement to the Human Rights Council

On 4 March the UNAIDS Secretariat addressed the Human Rights Council during its High Level Segment, underlining that the commitment that governments made to universal access by 2010 is a critical human rights imperative. The statement, delivered by Senior Human Rights and Law Adviser Susan Timberlake, noted that gains in recent years mean that nearly 4 million people are on antiretroviral treatment today, and numbers of new infections are falling. “If we build on momentum, universal access is a goal within reach.”

UNDP took the floor of the Council during the presentation of the report on HIV and human rights. It called on governments to promote an enabling legal environment in order to achieve universal access by 2010, including by repealing laws that discriminate against and criminalise men who have sex with men, sex workers and people who use drugs. It also stressed concern over the inappropriate criminalisation of HIV transmission and exposure in a number of countries, and the risk that such actions will undermine public health efforts to increase uptake of HIV testing and access to HIV prevention, treatment and care services.

The next session of the Human Rights Council will take place in June 2009

Credit: © UNICEF/UKRA01115/Pirozzi
UNICEF wants to help Ukraine’s many young injecting drug users protect themselves against HIV

Oksana is a teenage mother with a very young baby. She is also living on the streets of Kyiv, Ukraine’s capital. Having lost touch with her mother, who was sent to prison, she ran away from home to escape her abusive stepfather. She spends most of her day at the central railway station or the underground tunnels nearby but dreams of one day having a settled home for her son. These dreams are unlikely to be realised any time soon.

She is one of the many young people eking out a living on Ukraine’s streets who get no care and support. An unsafe social environment and high risk behaviour such as sex work and injecting drugs make young people living in the streets of Ukraine vulnerable to HIV. They are at the heart of an epidemic in the country worst affected by HIV in Europe and yet rarely have access to HIV prevention and treatment services.

One of the central aims of UNICEF in Ukraine is to try to help these most-at-risk young people, especially those who are homeless, to better protect themselves against HIV. Key activities include supporting outreach teams working with street children and adolescents, training social and health care workers and providing access to basic health services, education, training and housing.

According to the latest statistics, in 2006 more than 60% of injection drug users in Kyiv were living with HIV. In 2009, UNICEF conducted a study among street-based adolescents in several regions of Ukraine, which found high rates of drug use by injection, with two thirds of those having reported sharing needles. The study also revealed that one in ten male street adolescents had had sex with another male, often in exchange for money, clothes, or drugs.

Olena Sakovych is a UNICEF youth and adolescent development officer, who works closely with street children, as well as other most-at-risk adolescents. She is fully aware of the extent of the problem, with some young people initiating drug use by injection as early as age 13, and both boys and girls living on the streets often engaging in sex work at a similar age.

“These young people are the missing face of the HIV epidemic in Ukraine,” says Olena. “They need better care and more services. The situation here is critical. One of our main objectives at UNICEF is to make them visible to Ukraine’s political agenda and its AIDS response.”

The findings of the research informed the development of interventions and provision of health and social services to better address the needs of and help adolescents injecting drugs and engaging in sex work. In the city of Mykolyav, for example, outreach workers now recruit young female sex workers to a drop-in centre that offers a safe space, HIV counseling, and referrals to governmental health and social services centres, and non-governmental organizations that provide HIV prevention services, care and support.

Social workers accompany the women to those services, when necessary, which include gynaecological and infectious disease specialists, HIV treatment centres, and legal aid. Demand has far exceeded expectations. It was hoped that 50 under-aged sex workers would be recruited in the first six months. To date, well over a hundred adolescent girls have received services. A client satisfaction survey showed an increase in knowledge about HIV, as well as in motivation to seek help.

"UNICEF will continue to advocate for, and to support, country efforts to increase understanding of the epidemic and HIV prevention, protection, care and support services for most-at-risk adolescents,” says Susan Kasedde, UNICEF Senior Specialist on HIV Prevention among Adolescents. “In countries like Ukraine, until such services are made available, national epidemics cannot be stopped."

To this end, UNICEF promotes mobilization of governmental leadership; national and local political and community support; legislative and policy changes to enable wider access to HIV prevention and care services for most-at-risk adolescents, and strong partnership between the United Nations, government, civil society, young people themselves and people living with HIV.

“Ensuring that those most vulnerable to HIV infection like, young people on the streets, injecting drug users, those engaging in sex work, and men who have sex with men, have access to HIV prevention, treatment, care and support services is both a human right and a way to finally reverse the spread of the HIV epidemic,” says UNAIDS Country Coordinator Ani Shakarishvili. “Ukraine is continuing to make progress towards universal access but far more needs to be done. Strong political leadership and commitment will guarantee success. “