Pakistan’s capacity to effectively respond to the HIV epidemic could be hindered due to the lack of resources to implement its revised National Strategic Framework. The framework, endorsed by partners involved in the response, provides evidence-based strategic direction to urgently address the increasing levels of HIV infection amongst injecting drug users (IDUs) and other populations through sexual transmission and avoid a spillover to the general population.

Despite having an HIV prevalence of less than 0.1% among its general population, Pakistan’s HIV epidemic has transitioned from low to a concentrated one as the overall prevalence among IDUs has steadily increased from 10.8% in 2005 to nearly 21% in 2008.

In part, the region’s comparatively heavy burden of injecting drug use stems from the presence of long-standing trafficking routes for illicit opium. Opiates are the drug of choice for 65% of Asia’s drug rehabilitation patients, although drug use patterns vary greatly within the region. There are an estimated 91, 000 injecting drug users in Pakistan of which nearly one in four in large urban settings are infected with HIV.

An increase in resources available would increase the provision of harm reduction services that are producing positive results mitigating the spread of HIV amongst IDUs. Credit: P.Virot

Syringe Exchange Programs and Drug Harm Reduction including detoxification programs for IDUs are a priority in light of the epidemic trends among IDUs. Substantial scale-up of harm reduction and HIV prevention services started around 2002-2004 and the country is now set to pilot drug substitution among drug users. Harm reduction services are being implemented by partner NGOs which can play a pivotal role in reaching out and expanding the provision of such services.

Biological and behavioral surveillance studies have shown an increase in knowledge regarding HIV, increase in condom use and decreased sharing of syringes/needles among IDUs exposed to risk reduction program activities. However, coverage of these programs is still low. An increase in resources available would expand the provision of risk and harm reduction services that are producing positive results mitigating the spread of HIV among populations at higher risk.

Knowing your epidemic

Following the trend seen in other countries in Asia, also known as the Asian Epidemic Model, the epidemic in Pakistan is characterized by the rapid HIV transmission and high prevalence among IDUs in the initial stages and potential spill-over into other key populations at higher risk such as sex workers and men who have sex with men (MSM). Subsequently, through bridging populations such as partners and clients of sex workers, the epidemic could find its way into the general population. The connections and overlap between drug use and sex work coupled with high prevalence of unsafe sexual practices and low self risk awareness indicate that there is potential for rapid spread of HIV infection among key populations.

The overall HIV prevalence among injecting drug users in Pakistan has steadily increased from 10.8% in 2005 to nearly 21% in 2008. Credit: P.Virot

One of the implementation successes in the country is the 2nd generation surveillance for tracking trends in the epidemic. A country specific methodology has been developed, with mapping of risk groups in the first phase and collection of behavioral and biological data after mapping has been completed. This has provided up to date information on size of risk groups as well as on HIV prevalence among them.

Epidemiological evidence gathered over the last years has therefore confirmed Pakistan’s ‘concentrated’ epidemic. It has also underlined the low levels of adoption of HIV prevention measures in the general population and among youths.

Adapting the response

In line with the epidemic trend, supported by results from recent surveillance data, the Government of Pakistan has recently reviewed its National Strategic Framework (NSF-II). The new five year initiative (2008 – 2012) builds upon the initiatives outlined in the first national framework and renews focus towards rapidly scaling up prevention and HIV service delivery programs for most at risk populations.

The country has drafted its national AIDS policy and legislative framework, through the ‘HIV & AIDS Prevention and Treatment Act’, in order to support the government in providing services to populations at risk of acquiring HIV infection due to their occupation and/or practices. The basic provisions of the policy are intended to guarantee access to care, support and equitable access to treatment for people living with HIV. It is also intended to reduce stigma and discrimination against people living with HIV as well as to improve access to HIV specific information and prevention services.

“Pakistan has made substantial progress over recent years, including in addressing sensitive social issues and increasingly involving people living with HIV in the forefront of the AIDS response” says Oussama Tawil, UNAIDS Country Coordinator, “however, it is now critical that a collective effort be made to sustain the momentum in these life-saving measures”.

Lack of resources

AIDS could have a severe impact in certain communities over the coming decade. Financial and human resources are urgently needed to scale-up the provision of HIV prevention, treatment, care and support services. Credit: P.Virot

Despite having a thorough plan of action built upon evidence-based recommendations, the country is facing a shortage in resources that could jeopardize an effective and timely response to the epidemic.

A costing exercise undertaken by the Government estimated that the total fund requirement to implement the NSF II is US$ 293 million over five years. During 2006-2007, AIDS expenditure totaled US$ 29.67 million, with prevention-related activities having been allocated the biggest share (61%).

While resources have been made available to the country by the World Bank, bilateral funding and government resources, these funds are insufficient to cover the current needs and to create a sustainable long-term capacity to address the HIV response in the future.

AIDS could have a severe impact in certain communities over the coming decade. Financial and human resources are urgently needed to scale-up the provision of HIV prevention, treatment, care and support services in order to have a definite impact on the HIV epidemic and to mitigate its social and health consequences.

A version of this story was first published at www.worldbank.org

Small stipends paid directly to young girls have had a powerful impact on their school attendance in Malawi, reducing drop-out rates considerably and helping to protect them from HIV. That’s among the findings from a study, supported by the World Bank, of a two-year cash transfer programme targeting girls aged 13 to 22 that wrapped up in December 2009.

Stipends ranging from $1-$5 a month for the adolescent girls, in addition to payments to parents that ranged from $4-$10, reduced drop-out rates by approximately 40 percent.

And, for every extra dollar a girl received above $1, “enrolment increased by a percentage point,” says Berk Özler, a senior economist with the World Bank’s Development Research Group.

Özler and fellow researchers Sarah Baird of The George Washington University and Craig McIntosh of the University of California, San Diego, wanted to test the best way to use cash payments known as conditional cash transfers to boost school enrolment among young women in sub-Saharan Africa.

Drop-out rates are high among teenage girls in Malawi, one of the poorest countries in Africa. One of the main reasons is the relatively high cost of secondary school. Another is that Malawian girls tend to marry at a young age, and “once a girl is married, schooling is over,” says Özler.

Keeping girls in school who otherwise would have dropped out may not only increase learning, but delay marriage and reduce the rate of teenage pregnancy and sexually transmitted infections. Adult HIV prevalence in Malawi is around 12 percent, according to UNAIDS estimates.

In another paper, researchers found that the onset of sexual activity was significantly delayed among girls who took part in the programme, and their likelihood of being married or pregnant after one year had declined.

Past studies have suggested that “just the fact of being in school may lead to these desirable outcomes but the evidence was scant,” Özler says.

These current findings reinforce UNAIDS’ evidence-based contention that girls continuing their education greatly lowers their vulnerability to HIV. For those who stay in secondary school, each additional year means they are more likely to develop the skills and experience needed to keep themselves safe from HIV.

According to Patrick Brenny, UNAIDS Country Coordinator in Malawi, the study underlines the critical necessity of a comprehensive approach to reducing young women and girls' risk and vulnerability to HIV infection in Malawi.

“Staying in school is part of an effective ‘social vaccine’ with respect to sexual risk behaviour,” said Mr Brenny.

Empowering young people to protect themselves against HIV is one of the nine priority areas in the UNAIDS Outcome Framework 2009-11.

Cash transfers boost schooling, nutrition

In countries without adequate safety net support, children’s nutrition often suffers, and children, especially girls, are taken out of school. In an attempt to counteract this trend, some 29 developing countries have put in place some type of conditional cash transfers programme to boost schooling and nutrition, with many others planning on piloting one.

The World Bank backs conditional cash transfers programmes in 13 countries. It provided $2.4 billion to such initiatives in 2009 during the global economic crisis. Studies have found that cash payments to the female head of household leads to better outcomes for children and families. In Brazil, for instance, the chance of childhood survival increases by 20 percent.

But the effect of cash payments made directly to girls versus parents had not been studied until now.

Support to girls ‘makes sense’

In Malawi, the researchers wanted to find out whether the monetary amount of the cash transfer would make a difference, and whether making the payment conditional on school attendance would have an additional impact. They also wanted to test whether making payments directly to girls would affect the outcome.

The study involved a sample of 3,805 girls and young women aged 13 to 22 in 176 urban and rural areas in Zomba, a highly populated district with high dropout rates and low educational attainment. According to a 2005 government survey, children drop out of school mainly due to financial hardship.

Of these girls, a randomly selected group of 1,225 were either offered stipends on the condition they attend school 80 percent of the time, or offered the same stipends unconditionally. The rest did not receive any offers and served as the comparison group for the study.

Girls getting the monthly stipend participated in a lottery where they picked a bottle cap out of an envelope to win an amount between $1 and $5 a month. Guardians were also randomly assigned a separate amount ranging from $4 to $10 a month. On average, girls received $3 and their parents $7, meaning that cash payments to both girls and guardians totalled an average of $10 a month, but ranged from $5-$15.

Each household received an informational sheet detailing the amounts and conditions of the offer, if there were any, and the contract was signed by the girl and her guardian.

Özler says that the condition to attend school at least 80 percent of the time did not seem to make a difference to schooling outcomes in Malawi, nor did increased total cash payments above the minimum of $5 per month. That’s in contrast to the CCT experience in Latin America, where the condition to attend school has been key to the programme’s success.

The girls, however, were demonstrably motivated by their stipends, which they mostly spent on personal items such as clothing.

“The study was successful in getting dropouts to come back to school and in keeping girls in school. Maybe it makes sense to directly support adolescent girls,” says Özler.

The researchers are now conducting follow-up tests and surveys in Malawi to assess, among other things, the impact of the programme on maths and reading skills.

The study was funded by the Global Development Network; the Bill & Melinda Gates Foundation; the World Bank’s Gender Action Plan, Knowledge for Change Trust Fund, World Development Report 2007 Small Grants Fund, Spanish Impact Evaluation Fund, and Research Group; and the National Bureau of Economic Research in the United States.

A version of this story was first published at www.undp.org

Community conversations have proven to be an effective way to combat HIV in Namibia.
Credit: UNDP Namibia

What causes people to have more than one sexual partner at a time? “Sexual desire and satisfaction”; “It’s a cultural and social norm”; “Poverty and hunger; it’s a way to survive.” These are just some of the perspectives that emerged when communities under four traditional authorities came together to talk about what is known as ‘multiple and concurrent partnerships’ in the Caprivi region, in North East Namibia. This region is the most affected by the HIV epidemic in the country, where one in three pregnant women were found to be living with HIV in 2008.

The community conversations held late in 2009 is one of many taking place in throughout the country as part of a nationwide programme that engages communities in dialogue on the causes of HIV, boosting local responses to the epidemic.

The programme is known as ‘Community Capacity Enhancement through Community Conversations’. It is being implemented by the Namibian Ministry of Regional and Local Government, Housing and Rural development, with the support of the United Nations Development Programme (UNDP) in Namibia.

Multiple and concurrent partnerships have been identified as one of the main reasons why HIV has spread so rapidly in Namibia. “Long ago, marriages were respected. Nowadays, we have left this culture behind and both men and women have multiple sexual partners”, said one participant.

“By bringing together men, women and all those affected by HIV, this approach gives people the opportunity to make their voices heard, to identify their needs and to be counted when decisions about AIDS interventions are made,” says the Manager of UNDP’s Community Capacity Enhancement Programme, Immanuel Mwilima.

Community Capacity Enhancement through Community Conversations is a tried and tested methodology to boost the capacity of communities to identify concerns, deliberate on solutions and map out courses of action around AIDS.

Community members working with condoms during a community conversation on MCP in Katima Mulilo, Caprivi region.
Credit: UNDP Namibia

The approach opens up spaces for discussions based on relationships of trust and mutual respect.

According to Mr Henk Van Renterghem, UNAIDS Country Coordinator in Namibia, the community conversations offer a unique opportunity to strengthen the capacity of communities to engage with local government and development partners on the allocation of resources in the AIDS response.

“Too often communities are considered to be the passive recipients or beneficiaries interventions. They are inadequately consulted in top down processes for the identification of needs and priorities,” said Mr van Renterghem.

To date, communities in nine regions are conducting community conversations, with impressive results. In Caprivi, traditional leaders have led by example, going for voluntary counselling and testing and tackling the stigma associated with testing. In the words of one leader: “It is shocking that many of our relatives and loved ones have died because of AIDS....If this programme had come sooner, our relatives would have been alive today.”

Many challenges still remain in the AIDS response, however. For instance, 17.8% of pregnant women are HIV-positive in Namibia. “One of the biggest challenges facing rural communities in relation to accessing treatment, care and support services is stigma, discrimination, cultural norms and practices. Community Capacity Enhancement gives communities an opportunity to have an introspection of their cultural practices, norms and values,” says Lebogang Motlana, the Deputy Resident Representative of UNDP in Namibia. While the country is among the five most affected by HIV around the world, the epidemic is now on a downward trend, at just over 15%, after peaking at 22% in 2002.

Business.un.org  the new UN-business partnership gateway, was introduced today at the World Economic Forum Annual Meeting held in Davos, Switzerland. The website will provide a single entry point for to match the capacities and resources of the private sector with the needs of the UN System, be it for humanitarian relief, poverty reduction or HIV programmes.

The United Nations has long recognized that the private sector is a critical partner in addressing global challenges. And for companies willing to make a difference, the UN has the means and the reach to help sustain efforts on a global scale.

While many UN organisations have partnered with businesses for years, companies have frequently expressed frustration over the lack of a single interface describing UN needs across the multitude of specialized agencies, funds and programmes. The new platform aims to address offer companies a user-friendly process to share their resources and find appropriate partners.

According to Jan Beagle, UNAIDS Deputy Executive Director, the business sector is a key partner in the AIDS response. UNAIDS is works with the business sector to support the effectively delivery of HIV prevention, treatment, care and support services with the work place.

“The new UN-Business partnership platform is a uniquely positioned gateway to match the capacities and resources of the private sector with the needs of the AIDS response,” said Ms Beagle.

Through workplace programmes on HIV, in-kind contribution as well as donations, many corporations have shouldered their social responsibility in the AIDS response. UNAIDS has supported the development of business coalitions with the key ambition to establish work place programmes for HIV prevention services, expand access to care and treatment, and support for workers within the work place as well as the wider community.

How business.un.org works

Using the new partnership gateway, businesses seeking to contribute to the UN’s work can browse through a catalogue of available humanitarian needs and partnership opportunities, or simply submit ideas for collaboration. Based on shared characteristics, the site flags potential matches to be then connected directly.

The website also showcases examples of existing partnerships and provides operational guidelines to maximize the chance of success.

First launched on 14 January, business.un.org has quickly shown to be a useful mechanism to facilitate private-sector contributions to the humanitarian and development work of the United Nations.

Following the devastating earthquake in Haiti, businesses around the world have pledged both cash and in-kind contributions to support relief and redevelopment efforts in the Caribbean nation. Contributions offered through the portal include medical supplies, logistics support, food and water, shelter and communications equipment.

Business.un.org was developed as a collaborative effort of more than 20 UN agencies, funds and programmes. The site was designed and implemented by Global Hand, a Hong-Kong-based non-governmental organisation specialising in matching services for non-profit and for-profit organisations that partner to help a world in need. Project funding was provided by the UN Foundation. The new partnership gateway will be available in all six official UN languages by mid-2010.

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

As Haiti begins to rebuild after the destruction left by the 7.0 magnitude earthquake that struck 10 miles outside Port-au-Prince on 12 January, first reports are coming in on the impact the tremble has had on Haiti’s AIDS response.

Haiti is the country with the most severe HIV epidemic among the Caribbean states–home to half of all people living with HIV in the region. Before the quake, there were an estimated 120 000 people living with HIV in the country with an estimated 6 800 children under the age of 15 also carrying the virus.

Data is starting to emerge on people living with HIV who have been affected by the quake and on critical infrastructure needed to provide essential services. An initial report estimates that out of 120 000 people living with HIV just under 70 000 live in affected areas. Prior to the quake, around 19 000 people were estimated to be on Anti-Retroviral Treatment (ART).

“The world has a real opportunity to rebuild Haiti better, we must sustain the outpour of support now and tomorrow,” Mr Michel Sidibé UNAIDS Executive Director said when speaking of the pledges made by the international community.

The UNAIDS country team and cosponsors are working with the government of Haiti and partners such as PEPFAR and Global Fund to Fight HIV, TB and Malaria as well as non-governmental organisations to gather information to asses the impact of the quake on clinics, lab equipment and as well as human resources. It is now critical that HIV prevention, treatment care and support services are resumed in affected areas.

The UNAIDS country team met staff working in Haiti’s oldest ART centre GHESKIO. The organization provides treatment for 6000 people of whom 80% have now been accounted for.

UN Health Cluster coordination meeting in Port-au-Prince
Credit: UNAIDS

While the clinic has suffered some damage to its structure, essential equipment and tragically also suffered human losses, staff at GHESKIO reported that they have enough stock of anti-retrovirals to cover the immediate need.

Other centres were not as fortunate. The UNAIDS country team visited the Hospital de la Paix which provides prevention of mother-to-child transmission services in Port-au-Prince. Here staff reported destruction of stock as well as lack of financial abilities to buy breast milk substitute necessary to prevent transmission from mother to child through the breast milk. Services at the clinic were only resumed 12 days after the quake.

Members of the UN country team on AIDS will visit five major PMTCT centres in the coming days to establish if similar damages are found.

An initial situational analysis indicate immediate short term needs include limiting treatment interruption, provide nutritional support of people on treatment, and make sure PMTCT services are resumed. Networks of people living with HIV report that they urgently need food and water, tents, and hygiene kit in meeting with the UNAIDS country team.

In Haiti heterosexual transmission, often tied to sex work, is the primary source of HIV transmission although emerging evidence indicated that substantial transmission is also occurring among men who have sex with men. A challenge will be to ensure that key prevention commodities are made available to the displaced populations in and around Port-au-Prince.

“We are seeing real suffering. It is in moments like this where those most at risk are forgotten. We must ensure that the marginalized members of our communities have access to HIV prevention, treatment, care and support services,” Mr Sidibé said, promising that UNAIDS would be part of the global effort to support Haiti to build a better tomorrow.

UNAIDS is committed to working with the Haitian government and other development partners such as Global Fund and PEPFAR to look at how Haiti’s AIDS response can be strengthened over the long-term.

Support is needed to re-establish the AIDS-infrastructure as well as strengthening civil society, ensuring special attention towards HIV prevention, treatment, care and support services to populations at higher risk and put in place on coordinating authority to ensure no gaps or overlaps in the national response.

Michel Sidibé, UNAIDS Executive Director encouraged Qatar to increase its contributions to AIDS, health and development.
Credit: UNAIDS

During his official visit to Qatar, UNAIDS Executive Director Michel Sidibé encouraged the country to increase its contributions to AIDS, health and development at this critical time of the global recession.

“I believe that wealthier states, especially in the Gulf region, have a special responsibility to alleviate the world’s distress, and I encourage them to increase their contributions to AIDS, health and development at this critical time.” said Mr Sidibé.

In 2008, Qatar recorded a per capita GDP of US$ 72,000, among the highest in the world. Even under the global economic crisis, its GDP growth remained at 9.5%.

During his meeting with Doha's Minister of Health, H.E Abdullah bin Khaled Al Qahtani, Mr Sidibé congratulated the state of Qatar on its commitment to create a healthcare system that is aiming at providing the most effective and advanced healthcare for its people and become a model of the world to follow.

Since its formation in 2006, Qatar’s National AIDS Committee has taken major steps forward in the efforts to control HIV spread. This includes working closely with the industrial sector to limit HIV spread in the workplace, partnering with the United Nations Development Programme (UNDP) to establish a strategy on HIV prevention, and holding several workshops on HIV targeting community leaders from the media, the religious sector, and other community sectors.

In 2001, Qatar signed a Declaration on the TRIPS Agreement and Public Health that led directly to more than 4 million people gaining access to antiretroviral treatment for AIDS. The same year, Qatar made a pledge by signing a United Nations General Assembly Special Session Declaration of Commitment on HIV/AIDS.

Mr Sidibé highlighted the importance of public-private partnerships in helping the developing world launch itself on the path of sustainable development when he met Abdullah H. Al-Nameh, Executive Director and General Manager of the Qatar Charity, a non-government organization that supports the Qatari society and other needy communities abroad.

Established in 1992, the Qatar Charity focuses its work in the fields of humanitarian relief and development through the development of education and culture-related programmes targeting families, women and children. One of the largest charities in the Gulf, its activities covering more than 40 countries in Africa, Asia and Europe, the Qatar Charity uses its field offices or local civil society organizations as implementing partners.

 Credit: UNAIDS/P.Virot

The HIV epidemic in the Middle East and North Africa (MENA) region, while seldom highlighted, is steadily growing. In 2008 there were an estimated 310 000 people living with HIV, up from 200 000 in 2001. In that same year, approximately 35 000 people became newly infected with HIV in the region.

UNAIDS Executive Director Mr Michel Sidibé is in the region to draw attention to some of the key issues which need to be addressed to deliver an effective AIDS response, calling on countries to pursue equity and human rights in their approach to the HIV epidemic.

Stigma and discrimination remains key barriers to an effective regional response to AIDS and in many countries the criminalization of higher risk behaviors pushes affected communities underground–limiting access to HIV prevention, treatment, care and support services.

Given that populations at higher risk are disproportionally affected even in settings where overall HIV prevalence is low, for the good of the public health there is a need for acceptance. “Understanding is an imperative to draw those most at risk out of the shadows and enable them to protect themselves, and by extension, the entire community,” said Mr Sidibé.

UNAIDS’ work in the region

UNAIDS works closely with government and civil society partners in the region to advocate for the removal of punitive laws and polices that block an effective response.

In Yemen, on 29 August, the Parliament voted on a law to protect the rights of people living with HIV with the objective to reduce discrimination. This article 51 law is a major step to protect the rights of individuals living with HIV in the country.

In Egypt, an outreach programme for men who have sex with men has been initiated and in few months the project reached hundreds of people with services in a highly challenging environment. This programme is implemented by UNAIDS in partnerships with number of NGOs and with financial support from USAIDS and the Ford Foundation.

Another positive initiative was the first regional conference on Harm Reduction held in Lebanon last year. This conference was a break-through for the region and brought several experts and partners together and mobilized political support form parliamentarians, national governments and UN agencies.

Service provision for key populations is now also being expanded in the Middle East and North Africa region with oral substitution therapy for Injecting Drug Users programmes in Morocco and Lebanon. In Iran medical insurance is provided for people living with HIV and their families, where the insurance fees are completely paid buy the government. Theses success stories are significant and show investments towards universal access to HIV prevention, treatment, care and support much needed in the region.

Highlighting Human Rights at Qatar Conference

While in the region, Mr Sidibé attended the Colloquium on the Empowerment of the Family in the Modern World held in Doha, Qatar. Hosted by the Royal Family of Qatar and the Qatar Foundation in Doha, the Colloquium brings together scholars to discuss issues such as trends and challenges affecting the family, family and rights, and families around the world.

“Families offer the first defence line against stigma and isolation and as well as the primary source of care,” said Mr Sidibé in his key note address. The UNAIDS head also highlighted recent findings from the two year research project of the The Joint Learning Initiative on Children and HIV/AIDS. According to the report families take on approximately 90% of the financial cost of caring for infected and affected children.

Also of key concern is the freedom of movement for people living with HIV, disproportionally affecting migrant workers and their families. Qatar–as many others in the Middle East and North African region– imposes restriction on entry, stay and residence based on HIV status. Such restrictions are widely considered discriminatory and serve no public health benefit.

“Let’s leverage the solidarity of the global AIDS response to draw closer together as a global family unit to end human suffering and stimulate human achievement,” Mr Sidibé concluded his address.

Challenges ahead

To date, a shortage of timely and reliable epidemiological and behavioral data has hindered a clear understanding of the dynamics and trends of the HIV epidemic in the region. Although HIV prevalence remains low, populations at higher risk are often heavily affected; the epidemics in the countries of the region are typically concentrated among injecting drug users, men who have sex with men, sex workers and their clients.

Two broad transmission patterns have been identified. Firstly, many people are contracting HIV while living abroad, often exposing their sexual partners to infection upon their return to their home country. Secondly, HIV transmission is occurring within populations at higher risk such as injecting drug users or men who have sex with men, may also result in ongoing transmission to female sexual partners.

The UNAIDS 2009 AIDS Epidemic Update suggests intensified prevention efforts for the female sexual partners of men who are exposed to HIV during work abroad, drug use, sex with another man or sex with a sex worker.

Eric Sawyer handing over the Olympic flame.
Credit: UNAIDS

UNAIDS staff member Eric Sawyer carried the Olympic Flame in Calgary, Canada on 20 January as part of the 2010 Olympic Torch Relay leading up to the Winter Olympic Games in Vancouver, to be held from 12-28 February.

Prior to working for UNAIDS he founded three HIV organizations in the US, including ACT UP/New York -- an international advocacy group working to defend the rights of people living with HIV. He has been living with HIV for the past 30 years.

Speaking about being chosen as an Olympic torchbearer, Mr Sawyer said, “I am a long term survivor of HIV and have been fortunate to have been able to buy almost 30 years of life after becoming symptomatic with HIV in 1981, because I have had access to the latest medical treatment and care. The fact that I am still able to run a segment of the relay is a clear example of the need to provide everyone living with HIV with the information, treatment, care and support.”

Mr Sawyer is also member of UN Plus, the UN system-wide advocacy group of staff living with HIV.

UNAIDS and the International Olympic Committee (IOC) has a long-standing partnership to enhance the role of sports organisations in the AIDS response. This joint venture was formalized in a Memorandum of Understanding signed in 2004. The two organizations have also collaborated in efforts to raise HIV awareness with coaches, athletes and sports personalities around the world.

Praising the work of the IOC, UNAIDS Executive Director Michel Sidibé stressed the importance of partnerships like this one for the AIDS response, saying “By working together in the spirit of the core values of the Olympic Movement—friendship, excellence and respect—we can be a force for positive change.”

Jacques Rogge, the President of the IOC, said, “The IOC and UNAIDS both try to reach out to as many young people as possible. It is our common goal to use sport as a powerful tool in the education about and the prevention of HIV and AIDS across the globe.”

For the Vancouver Games, UNAIDS has helped develop HIV education, prevention and awareness packages that will be distributed to volunteers, workers and athletes alike. In addition to literature that educates individuals about the risks of HIV transmission, the packages contain male condoms as well as information on safer sex.

Eric Sawyer is a staff member of UNAIDS and has been living with HIV for 30 years.
Credit: UNAIDS

“As a person living with HIV, I am glad to see that the prevention packets are being distributed to all involved in the Olympic Games experience. Just as a downhill ski coach provides his athletes with information, training, goggles and a helmet to safely ski down a slalom run, information and commodities must be provided to everyone so that when they engage in sexual relations they are protected from sexually transmitted infections and unplanned pregnancies.”

The IOC has asked UNAIDS to nominate people living with HIV as bearers of the Olympic flame in the relay to help break down the barriers of stigma and discrimination.

Dhamiri Mustapha, a young Tanzanian woman living with HIV, was one of the 80 dignitaries who carried the Olympic Flame in Dar Es Salaam, Tanzania, ahead of the 2008 Summer Olympic Games in Beijing. In the run up to the 2004 Summer Olympic Games in Athens, UNAIDS nominated 31-year-old South African Musa Njoko to participate in the Olympic Torch Relay in Cape Town.

The partnership between UNAIDS and the IOC was particularly successful during the recent 2008 Summer Olympic Games in Beijing. The “Play Safe – Help Stop HIV – Play your part in protecting the world around you” campaign for the Beijing Games was jointly planned and executed by the IOC, the Beijing Organizing Committee for the Games of the XXIX Olympiad and UNAIDS. UNAIDS mobilized nine UN agencies, the Red Cross, Marie Stopes International as well as groups of people living with HIV to train 7,000 Olympic volunteers on HIV prevention and countering stigma and discrimination.

Half of all people living with HIV globally are now women and this figure rises to over 60 per cent in sub-Saharan Africa, where young women aged 15-24 can be several times more likely to be HIV-positive than their male counterparts. In order to offer women greater protection against the virus, the World Health Organization (WHO) has designed a hands-on tool to integrate gender into AIDS programmes in the health sector.

The impact of the epidemic on women is exacerbated by a number of factors women can face, including economic dependence on men which may limit their ability to refuse sex or negotiate condom use; their relatively low status, their vulnerability to violence, and lack of access to information and education about HIV. Such inequalities affect women’s experience of HIV, limiting their ability to cope once infected. In 2001 and 2006, the UN General Assembly Declarations of Commitment on AIDS spelled out the need for member states to address gender inequality as a major driver of the epidemic.

Field-tested in five countries (Belize, Honduras, Nicaragua, Sudan and Tanzania), the new tool helps those planning and implementing AIDS programmes in the health sector to better understand the links between gender inequalities and the virus. It raises awareness of how these inequalities influence women’s access to, uptake of, and experience with such programmes and services in the health sector.

The manual also gives practical suggestions to managers and health care providers, both public and private, on how to integrate gender into HIV programmes, rendering them more responsive to women’s needs. Informing national AIDS strategies, frameworks, guidelines and operational plans the tool can also be used by practitioners in their day to day work.

One AIDS service provider in Lindi, Tanzania believes that use of the tool in training him has been highly beneficial. “I am a role model in the society and my male fellows will be astonished if I bring gender issues as a man. But because I am a role model, I will do it.”

In addition to describing basic steps in gender-responsive programming, the manual suggests concrete actions to address key gender issues in four service delivery areas; HIV testing and counselling; prevention of mother-to-child transmission; treatment and care and, finally, home- based care and support for people living with HIV.

It also offers examples of gender-responsive interventions from the field, and resources such as counselling role plays for risk-reduction and HIV treatment adherence, and protocols for addressing the risk of violence against women as a result of HIV status disclosure. While citing specific examples, WHO suggests that the tool should be adapted to suit the specifics of each national and local environment.

The manual is seen as a work in progress which will be updated and revised as necessary for use by those who, according to WHO, are committed to gender equality and the health and well-being of all.

As part of the United Nations family, UNAIDS stands in solidarity with the people affected by the devastating earthquake that struck Port-au-Prince on Tuesday 12 of January.

On Sunday United Nations Secretary-General Mr Ban Ki-moon reiterated the UN’s continued support to Haiti and the people affected by this natural disaster. Speaking in Port-au-Prince, Mr Ban ensured that the search and rescue operation for people trapped in the rubble was still ongoing.

As emergency relief efforts, with food, water and tents being distributed by the UN and its partners are stepped up; the UN Secretary-General stressed the importance of coordination of the emergency operation.

“My heartfelt sympathies are with the people of Haiti in these difficult times,” said Mr Michel Sidibé, UNAIDS Executive Director. “As the UN Secretary-General Ban-Ki moon has said, the international community must support Haiti during this crisis and in the long term.”

On Friday the 15 the UN launched a flash appeal for $ 600 million, which outlines the support needed to start meeting the devastation suffered by Haiti. This includes support for the National AIDS Response, and delivery of HIV prevention, treatment, care and support services.

The United Nations family too has been affected by the earthquake and it is still uncertain of the status of many of the staff. UNAIDS has accounted for all of its staff in the UNAIDS Country office and has pledged support during this crisis.

Amidst the uncertainties the world body's peacekeeping and field support departments are utilizing the social networking sites Facebook and Twitter to keep families, friends and colleagues of UN personnel in Haiti up-to-date on the latest developments