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. “

(L to R) Hon Sasa Zibe, PNG Minister of Health and HIV/AIDS, Governor General Sir Paulius Matane and Hon Misa Telefoni, Chairperson of the Pacific AIDS Commission and Deputy Prime Minister of Samoa during the simultaneous launch of the Pacific AIDS Commission Report and the National HIV Prevention Strategy 2010-2015. PNG, 11 March 2010.

The first Pacific launch of the report “Turning the Tide: An OPEN strategy for a response to AIDS in the Pacific” took place in Papua New Guinea on Thursday 11 March 2010. The 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.

The report was officially launched by the UN Secretary-General in New York on 2 December 2009. It was produced by the Commission on AIDS in the Pacific, an independent body established to provide an objective and independent analysis of the status and impact of the HIV epidemic in the Pacific region.

“UNAIDS fully supports this report and finds that many of the recommendations in the report align very closely with the priorities identified in the Outcome Framework for Action agreed by all the 10 cosponsors and the secretariat of UNAIDS” said Mr Sidibé.

According to the report, a number of factors have hindered the region’s response to the epidemic. Limited awareness and understanding of the potential impact of the epidemic, weak health care systems and an unsupportive legal environment have all contributed to varying degrees of success by Governments across the region. The report has clearly highlighted the factors inhibiting a strong and determined response to the epidemic. While some of these are known, it is for the first time that all the issues were addressed by the Commission.

His Excellency Sir Paulias Matane, Governor General of Papua New Guinea officiated the national launch of the report together with Honourable Deputy Prime Minister of Samoa and the Chair of the Commission on AIDS in Pacific. J.V.R. Prasada Rao, Special Advisor to the UNAIDS Executive Director delivered a speech on behalf of UNAIDS Executive Director Michel Sidibé.

Uneven response in the region

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.

Papua New Guinea makes up the largest share of cases, growing exponentially from 21% in 1984–1989 to over 99% in 2008. Reported cases in Papua New Guinea total 28,294 but UNAIDS estimates there are 54,000 people living with HIV. It is estimated that by 2012, Papua New Guinea will have a national prevalence rate of 5.07% and a total of 208,714 people will have been infected with HIV.

The predominant means of HIV transmission in the region is unprotected sex. The number of HIV-positive young people is steadily increasing and young women are infected earlier than young men. New Caledonia, French Polynesia and Guam have identified unprotected male-to-male sex and injecting drug use as key issues to address to effectively respond to the epidemic.

The report states that a “one size fits all” response does not suit the diversity of Pacific nations and outdated legislation criminalizing homosexuality and sex work is a major impediment in the region.

A review carried out by the 2009 Reference Group to the UN on HIV and Injecting Drug Use concludes that coverage of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide is very low and unlikely to be sufficient to prevent, halt, or turn around HIV epidemics. Credit: UNAIDS/P.Virot

A review carried out by the 2009 Reference Group to the UN on HIV and Injecting Drug Use for the first time quantifies the scale of coverage of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide. The study concludes that with, specific exceptions, worldwide coverage of these services in IDU populations is very low and unlikely to be sufficient to prevent, halt, or turn around HIV epidemics.

The paper, published by The Lancet in its online edition of 1 March 2010, also highlights the need for improved data collection on injecting drug users in each region in order to get a clearer picture of the extent of their needs. “We still do not know enough about the nature and size of the populations we need to target.”

Already the gaps in services are apparent. In prevention, the study estimates that two needles per month were distributed per person who injects drugs. In the countries that estimate the number of condoms distributed to IDUs, an average of 12 condoms were distributed to each IDU per year.

These global averages hide even greater regional and national variations in services.

While nearly all countries in western and eastern Europe, central Asia, Australasia, and North America had needle and syringe programmes (NSPs), these services aren’t present in nine of 25 countries in east, southeast, and south Asia where injecting drug use occurs. NSPs were also absent or unreported in 14 of the 16 countries in sub-Saharan Africa where injecting drug use occurs.

Opioid substitution therapy (OST) coverage also varied from 1% or less of IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels of 61% in western Europe.

Access to services for all drug users

UNAIDS believes that drug users can be protected from becoming infected with HIV if comprehensive, evidence-informed and human-rights-based interventions are made accessible to all drug users.

“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,” said UNAIDS Executive Director Michel Sidibé. “But current coverage of these services is appallingly low.”

The study was funded by the UN Office on Drugs and Crime (UNODC), Australian National Drug and Alcohol Research Centre, University of New South Wales; and Australian National Health and Medical Research Council.

(L to R): Minister of State for International Development Gareth Thomas, artist, political and social activist Annie Lennox, UNAIDS Executive Director Michel Sidibé and Executive Director of the Global Fund Professor Michel Kazatchkine
Credit: UNAIDS

AIDS is not over in any part of the world and as such country driven goals towards universal access to HIV prevention, treatment, care and support need to remain a priority. This was a recurrent message told by more than 40 champions and leaders of the AIDS response who gathered for a meeting at the House of Lords organized by United Kingdom’s Department for International Development (DFID).

In 2006, world leaders adopted a declaration at the United Nations General Assembly committing to achieving universal access to HIV prevention, treatment, care and support by 2010. DFID was central in helping to build momentum at the G8 and other international fora. Civil society’s role was crucial in shaping this commitment and holding leaders accountable.

Since then, many countries have met some of the goals. More than four million people living with HIV are accessing treatment. There has been a significant drop in new HIV infections since 2001. In sub-Saharan Africa, there were 400,000 less new infections in 2008. Millions of pregnant women tested and counselled for HIV. Thousands of HIV positive pregnant mothers being provided the necessary treatment and support to stop passing HIV to their babies. More than 5 million orphans are receiving social support. Funding for HIV programmes have increased—from development partners and domestic sources reaching US$ 16 billion in 2008.

“We can be proud of what we have achieved,” said Mr Michel Sidibé, Executive Director of UNAIDS. “We have given hope and restored dignity to the millions of people living with HIV across the world.”

Ambassador Eric Goosby, the United States Global AIDS Coordinator, added that the achievements made by countries put them in a better position to say that the resources available are not enough.

From the civil society perspective, Professor Narciso Matos the Director of the Foundation for Community Development in Mozambique said that much of the success has been the number of stakeholders involved “especially the role of religious groups”.

However many countries have yet to reach all their targets. His Royal Highness Chief Mumena of Zambia gave the example of voluntary counselling and testing. He talked about the fact that most people in his country live many miles away from health centres and that the cost of bus fare made visits prohibitively expensive.

Many talked about the resources that the world will need to continue to tackle AIDS. Public opinion about bailout packages given to the private sector has brought new perspectives on funding for development and health issues including ideas around a transactional tax. The AIDS response has been at the forefront of innovation in health financing including UNITAID and MASSIVEGOOD. Initiatives like PEPFAR have changed the way the world works on AIDS.

In summarizing the main points of the meeting, MP Gareth Thomas, Minister of State for International Development, pointed out the importance of the Global Fund Replenishment and the World Bank Replenishment as well as country ownership to continue towards universal access goals.

Ms Vuyiseka Dubula, the General Secretary of the Treatment Action Campaign from South Africa reminded participants the importance of taking care of their own citizens but also to “treat other people beyond their borders”.

Members of the public take part in "Race for life" in Kiev, Ukraine. With an adult HIV prevalence of 1.6% in 2007, Ukraine has the largest HIV prevalence in Europe. Credit: UNAIDS

An estimated 1.5 million adults and children are living with HIV in Eastern Europe and Central Asia. With an adult HIV prevalence of 1.6% in 2007, Ukraine has the largest prevalence in all of Europe. Estonia, Russian Federation and Ukraine all have HIV prevalence that exceeds 1%.

Experts are concerned that the epidemic continues to outpace the response.

“There has been a dramatic increase in the estimated number of people living with HIV in the Eastern Europe and Central Asia region since 2001, an increase of as much as 66%,” said Dr Denis Broun, Director of UNAIDS Regional Support Team for Europe and Central Asia.”Conversely, during the same period, HIV prevalence decreased by 5% in Asia, " he continued.

There have been improvements in the region including a growth in access to HIV treatment services leading to lowering mortality from AIDS. Also there has been an increase in prevention of mother-to-child HIV transmission services which are helping to reduce the number of babies born with HIV. Community participation in the AIDS response has been strengthened with progressively more meaningful involvement of people living with HIV, civil society and religious organizations.

Prevention services for those most-at-risk

Given that injecting drug use is the major mode of HIV transmission across Eastern Europe and Central Asia, HIV prevention among drug users and their sexual partners should be a vital component of AIDS responses in the region. However HIV prevention services, and in particular prevention work among vulnerable groups and young people have not been scaled-up with the rising numbers of infections.

“It’s essential to have much more aggressive prevention in the region. HIV prevention makes sense for human society, both economically and strategically,” said Dr Broun.

Regional leadership in CIS 

(from left) Dr Denis Broun, Director of UNAIDS Regional Support Team for Europe and Central Asia; Georgiy Narushevich, the Adviser to the CIS Executive Committee. Credit: UNAIDS

A major step towards a more strategic AIDS response was achieved at the expanded meeting of the Commonwealth   of Independent States (CIS) Coordination Council on HIV/AIDS which took place recently in Moscow

Representatives of ten member states of the CIS with participation of community of people living with HIV in the region, discussed actions for the implementation of the 2009-2013 CIS Programme of Joint Actions on HIV/AIDS.

This Programme was approved by the Council of the CIS Heads of Government last November. It will facilitate the introduction and practice of fundamental principles in the HIV response in CIS countries. For example, to improve coordination within countries via a single national AIDS programme, with one coordinating body and one agreed country-level monitoring and evaluation system.

Also, to turn the tide of the epidemic, other strategies were identified such as providing access to free, voluntary and confidential HIV counseling and testing and national prevention programmes to reach young people and key populations at higher risk.

A dialogue about and reporting on the implementation of the Programme of Joint Actions will continue with UNAIDS with ongoing support offered online and at regular working groups meeting.

Expanded meeting of the Commonwealth of Independent States Coordination Council on HIV/AIDS. Moscow, 25-26 February, 2010.
Credit: UNAIDS

The discussion took place against the backdrop of reviewing the progress in achievement of Universal Access targets by 2010. Participants also outlined the urgent measures to be taken to accelerate progress. This meeting of the CIS Coordination Council on HIV/AIDS was an opportunity to review progress and challenges in scaling up universal access to HIV prevention, treatment, prevention, care and support.

“We reached a consensus on the priority measures for implementation of the Programme of joint actions at the meeting,” Georgiy Narushkevich, the Adviser to the CIS Executive Committee commented.

“That’s a major achievement in consolidation of the HIV response at the high political level.”

Deputy President Kgalema Motlanthe (left) met with Professor Michel Kazatchkine, Executive Director of the Global Fund (right) and Michel Sidibé, UNAIDS Executive Director (second from right). Luthuli House, Johannesburg 8 March 2010. Credit: Juda Ngwenya/The Global Fund

South Africa is transforming its AIDS response. Today, the Deputy President of South Africa HE Mr Kgalema Motlanthe met with Executive Directors of UNAIDS and Global Fund in Johannesburg. He recommitted his government’s commitment to meet their universal access targets.

“AIDS is one of the top priorities for South Africa and we will work with development partners and civil society,” said Deputy President Mr Motlanthe.

In its annual budget for 2010-2011, the country has proposed a budget of US$ 1.1 billion for the AIDS response, the biggest domestic investment in a developing country. South Africa has recently taken the responsibility of providing antiretroviral treatment from its own budget and aims to provide access to nearly 2.1 million people living with HIV.

“A successful AIDS response in South Africa can break the trajectory of the global AIDS epidemic,” said Mr Michel Sidibé, UNAIDS Executive Director. “South Africa must lead the region in stopping all new infections and providing treatment for everyone who needs it.”

At the meeting the Deputy President also pledged to support the regional and global AIDS response and advocate for a fully funded Global Fund. The Global Fund also invited the Deputy President to participate in the Third replenishment conference that will be chaired by the UN Secretary-General Ban Ki-moon in October this year. Sustaining investments in health and development are critical if the world has to reach the millennium development goals

“We welcome South Africa’s support in fully funding the Global Fund,” said Dr Michel Kazatchkine, Executive Director. “We cannot afford to let down the millions who are still waiting to receive treatment and prevention services.”

UNAIDS also called on South Africa to leverage the upcoming football 2010 FIFA World Cup to mobilise the global community on preventing HIV transmission to children. “We can eliminate mother to child transmission of HIV by the time the next World Cup is played in Brazil,” said Mr Sidibé. “From Soweto to Rio de Janeiro, we have to show the red card to AIDS for stopping babies from becoming infected with HIV.”

At a separate meeting of civil society representatives working on issues of maternal health, TB, HIV and malaria, participants urged for a synergetic approach to ensure that health rights are realised. 8 March 2010. Credit: Juda Ngwenya/The Global Fund

At a separate meeting of civil society representatives working on issues of maternal health, TB, HIV and malaria, participants urged for a synergetic approach to ensure that health rights are realised. Recent evidence shows that many maternal deaths are now associated with HIV. South Africa has pioneered the integration of HIV and TB services under one roof. Efforts such as these complement each other as well as increase efficiencies. South Africa leadership-political, civil society and people are together bringing about change—for the better.

Virtual elimination of mother to child HIV transmission by 2015 is now within reach if current rates of progress by Global Fund-supported programmes and other efforts are maintained. Malaria may be eliminated as a public health problem within a decade in most countries where it is endemic. Tuberculosis prevalence in many countries is declining and the international target of halving TB prevalence could be met by 2015.

These are projections from the Global Fund’s 2010 Results Report, released today. They are contingent on the current rate of scaling up of health investments for the three diseases being at least maintained and ideally accelerated further.

“A world where no children are born with HIV is truly possible by 2015,” says Professor Michel Kazatchkine, Executive Director of the Global Fund. “It is also possible now to imagine a world with no more malaria deaths, since already an increasing number of countries have been reporting a reduction in malaria deaths of more than 50 percent over the past couple of years. No other area of development has seen such a direct and rapid correlation between donor investments and live-saving impact as these investments in fighting AIDS, TB and malaria.”

According to the report, Global Fund-supported programmes saved at least 3,600 lives per day in 2009 and an estimated total of 4.9 million since the creation of the Global Fund in 2002. These are people who would otherwise be dead, had it not been for interventions supported by the Global Fund.

“The Global Fund is about getting results. This report clearly shows the world’s investments are making a difference,” said Mr Michel Sidibé, Executive Director of UNAIDS. “However AIDS is not over in any part of the world and without a fully funded Global Fund, our shared dream of universal access to HIV prevention, treatment care and support could become our worst nightmare—putting the lives of millions of people currently on treatment in jeopardy and millions of pregnant women in a position not able to protect their babies from becoming infected.”

The Results Report forms part of the documentation for donors in preparation for the Global Fund’s replenishment conference in October 2010 in New York, where the organization will ask donors for financial contributions for 2011-2013. This is the third time since the Global Fund was established in 2002 that donors are being asked to replenish its finances.

At an initial Replenishment review meeting to be held in The Hague on 24 March, the Global Fund is presenting three resource scenarios for consideration to donors, each with an indication of the results that could be expected in terms of achievements on the ground at the end of the replenishment period. The different scenarios range from US$ 13 to 20 billion for the three-year period.

By the end of 2009, Global Fund-supported programmes provided antiretroviral treatment to 2.5 million people, treatment to 6 million people who had active TB and had distributed 104 million insecticide-treated nets to prevent malaria. In addition to averting at least 3,600 deaths daily, the programmes prevent thousands of new infections and alleviate untold suffering and economic loss for poor families in 144 countries.

Established as a public-private partnership to mobilize and intensify the international response to the three global epidemics and help achieve the UN Millennium Development Goals (MDGs), the Global Fund has disbursed US $10 billion for HIV, TB and malaria efforts through December 2009.

The coming years will see even more results, as half of the total disbursements by the Global Fund were delivered in 2008 and 2009. In addition, much of the US$ 5.4 billion of financing approved in the last two rounds of proposals (8 and 9) will reach countries in 2010 and 2011, and will continue to significantly boost health outcomes.

The progress in combating AIDS, TB and malaria as a result of these investments has also had a positive impact on child mortality and maternal health. The MDGs call for halting and reversing the major diseases as well as reducing child mortality and improving maternal health by 2015.

Global Fund grants have made significant contributions to reducing the largest causes of mortality among women and children. This is particularly the case in sub-Saharan Africa, where HIV, TB and malaria are responsible for 52 percent of deaths among women of childbearing age and malaria alone accounts for 16 to 18 percent of child deaths.

HIV and TB results up to December 2009

HIV

• 2.5 million people are currently on antiretroviral therapy (ART), a level of coverage deemed unattainable less than a decade ago.
• AIDS mortality has declined in many high-burden countries.
• The Global Fund contributed about one-fifth of all disbursements by bi- and multilaterals for the HIV response in low- and middle-income countries in 2008.
• 1.8 billion condoms distributed.
• 105 million HIV counseling and testing sessions provided.
• 790,000 HIV-positive pregnant women in low- and middle-income countries received antiretroviral prophylaxis to prevent mother-to-child transmission– which represents 45 percent of coverage of women in need.
• 4.5 million basic care and support services provided to orphans and other children made vulnerable by AIDS.

Tuberculosis

• Around 6 million people with active TB were treated by December 2009.
• 1.8 million TB/HIV services provided – a 150 percent increase since the end of 2008, contributing to the decline of TB prevalence and mortality rates in many countries.
• The Global Fund provides 63 percent of the external financing for TB and multidrug-resistant TB (MDR-TB) control efforts in low- and middle-income countries – it is by far the major source of international funding for tuberculosis.
• Today, countries are on track to meet the international target of halving TB prevalence by 2015.

Progress towards meeting Millennium Development Goals

The report points out that continued, substantial increases in long-term financial commitments by donors will be needed to consolidate the gains and to reach the MDGs by 2015.

Within that time-frame, 2010 is decisive.

Funds committed now will benefit programmes which will have effect on the ground from 2012 to 2015. The numbers show that countries are approaching a positive tipping point: if they continue on this path, the returns will be exponential and the world will reverse the AIDS, TB and malaria epidemics.

“In health, 2010 is a pivotal year to finance the final stretch of the effort to reach the Millennium Development Goals”, says Professor Kazatchkine. “We have made unprecedented progress but it is fragile. If we lose momentum now there will be a heavy price to pay. A failure to continue the scale-up of investments in health will betray the trust of millions.”

Examples of South Africa’s successes in the fight against HIV and China’s successes in tuberculosis can be found throughout the report.

South Africa has stepped up a rapid expansion of HIV prevention, care and treatment services. The Global Fund disbursed US$ 97.2 million for HIV grants and US$ 87.2 million for TB/HIV grants by the end of 2009 to support the South African efforts to respond to HIV. Activities focused mainly on behavior change communication, provision of ART and TB/HIV collaborative activities. Initially, the Global Fund financed much of the scale-up of ART, but more recently the government has assumed financial responsibility for provision of ART. Between December 2007 and December 2008, the number of people receiving ART in South Africa increased by 53 percent, from 458,951 to 700,500. As ART coverage has increased, mortality rates, which had been rapidly increasing in previous years, stabilized.

The Global Fund has made a substantial contribution to China’s TB control efforts, with a total approved amount of US$ 452.3 million, of which US$ 165.6 million was disbursed by the end of 2009, accounting for about 15 percent of the national TB programme budget. In 2007, China had achieved 100 percent DOTS – the basic package that underpins the Stop TB strategy - coverage and an 80 percent case detection rate for new smear-positive cases. Treatment success reached 93 percent, exceeding the international target of at least 85 percent. The TB burden in China has been steadily declining. Between 2000 and 2008 the TB mortality rate declined from 9.8 to 5.4 per 100,000 population. However, Multi-drug resistant TB is increasing in some parts of China and is becoming a major challenge.

Since its creation in 2002, the Global Fund has become the dominant financier of programmes to fight AIDS, tuberculosis and malaria, with approved funding of US$ 19.2 billion for more than 600 programmes in 144 countries. To date, programmes supported by the Global Fund have saved 4.9 million lives through providing AIDS treatment for 2.5 million people, anti-tuberculosis treatment for 6 million people and the distribution of 104 million insecticide-treated bed nets for the prevention of malaria.