In a supplement of the Journal of AIDS’ December issue published yesterday, UNAIDS explores some of the current challenges to monitoring the progress towards global HIV targets.

The supplement, called Progress Towards Global HIV Targets: Challenges in Monitoring National Indicators, explores thematic, technical analysis of data and key findings derived from the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) reporting system.

The issue was guest co-edited by Dr Deborah Rugg, Chief Monitoring and Evaluation UNAIDS and covers issues such as human rights in the global response to HIV and estimating the level of HIV prevention coverage, as well as addressing the key question: Are we on course for reporting on the Millennium Development Goals in 2015?

“In a time of ever more acute resource limitation, more and better studies are required that effectively evaluate whether programmes achieved their desired results, and whether those results lead to their intended outcomes,” said Dr Rugg.

The 2001 UNGASS Declaration set forth concrete, time-bound commitments to promote a comprehensive and effective global response to the epidemic. The UNAIDS Secretariat was subsequently given a mandate to develop an international monitoring system for national HIV responses in order to manage this reporting.

The resulting system has generated an unparalleled global body of evidence across the range of national HIV responses and key thematic areas.

The articles included in the supplement uses data and key findings derived from the UNGASS reporting system, combined with complimentary data from other sources, on the status of both the global HIV epidemic and the response.

A new report by Health Canada’s International Affairs Directorate has called for a greater focus on rights of people with disabilities in HIV policy. The report makes recommendations for policy change and follows an International Policy Dialogue held between UNAIDS, Health Canada and the Public Health Agency of Canada in Ottawa in March 2009.

Titled “HIV/AIDS and Disability: Final Report of the 4th International Policy Dialogue”, it calls for the United Nations' Convention on the Rights of Persons with Disabilities (CRPD) to become a catalyst for change by shifting the disability discourse from charity-based or medical-based approaches to a rights-based approach. This approach views people with disabilities as active participants in society, ensuring their wellbeing rather than treating them as passive recipients of charitable goodwill.

The report recommends the involvement of stakeholders in helping CRPD become a tool for change. These stakeholders include WHO, UNICEF, UNAIDS, national governments and ministries and civil society organizations working in the areas of disability and HIV.

There is a double stigma experienced by people living with both HIV and disability. Much effort is required to overcome this, beginning with raising awareness and open communication. For example, in South Africa youth with disabilities are trained to provide HIV prevention and treatment information to their peers; in Kenya HIV screening information is provided to the deaf by the deaf; and Uganda has established mental health clinics for people living with HIV. The report suggests taking a lead from these programmes.

It calls for service providers in the AIDS response to be sensitised on how to interact with people with disabilities and to establish mobile voluntary counselling and treatment services to increase access to people living with disabilities who are unable to reach them on their own.

The HIV and Disability report recognises the need for more education and awareness for children, youth and adults living with developmental disabilities, and also suggests working on providing information on sexual and mental to people with disabilities.

The report discusses challenges related to sustaining pilot projects, securing funds, sharing the results and benefits of HIV, AIDS and disability projects, and educating donor countries, governments and NGOs in the value of investing in this area.

UNAIDS, along with WHO and the United Nations Office of the High Commissioner for Human Rights, has collaborated on a policy brief exploring the links between HIV and disability and that also makes recommendations for policy change.

Apart from discussing the actions needed to increase the participation of persons with disabilities in the HIV response and to ensure they have access to HIV services, it also recommends for governments to incorporate persons with disabilities into their national HIV policies.

It also urges civil society to ensure campaigns to combat stigma and discrimination of people living with HIV are also accessible to persons with disabilities and advocates for the latter to be included in planning, implementation and evaluation of HIV programmes.

People with disability

Around 650 million people, or 10% of the world’s population, have a disability. Although people with disabilities are found within the populations at higher risk of exposure to HIV, not much attention has been paid in the past to the relationship between HIV and disability.

Participants in breakout groups at the International Policy Dialogue, held in Ottawa, Canada, March 2009
Credit: Health Canada

People with disabilities and people living with HIV shared their personal experiences during the International Policy Dialogue in March to give voice to both the challenges they face and the abilities they hold.

Persons with disabilities experience all of the risk factors associated with HIV, and are often at increased risk because of poverty, severely limited access to education and health care, lack of information and resources, lack of legal protection, increased risk of violence and rape, vulnerability to substance abuse, and stigma.

Women living with HIV are more likely to have experienced violence, and women who have experienced violence are more likely to have HIV infection. Credit: UNAIDS/P.Virot

Numerous studies from around the globe confirm the links between violence against women and HIV. These studies show that women living with HIV are more likely to have experienced violence, and that, women who have experienced violence are more likely to have HIV infection.

From 27-29 October the World Health Organization (WHO), on behalf of the UNAIDS family, convened a working group of experts and practitioners to review evidence around the links between violence against women and HIV, as well as programmatic interventions and strategies which address the intersections of violence and HIV. The aim of the meeting was to make policy and programmatic recommendations for national and international AIDS programmes as well as to develop an agenda for future programme development, evaluation and research efforts based on a review of evidence from different interventions.

The meeting was part of UNAIDS efforts to operationalize the Joint Action for Results: the UNAIDS Outcome Framework, which includes violence against women and girls as one of its nine priority areas.

Violence and HIV

According to a 2006 report by United Nations Secretary-General one out of every three women around the world has been beaten, coerced into sex, or otherwise abused in her lifetime, usually by someone known to her.

Violence and the threat of violence dramatically increase the vulnerability of women and girls to HIV by making it difficult or impossible for women to abstain from sex, to get their partners to be faithful, or to use a condom. The risk of HIV transmission increases during violent or forced-sex situations as the abrasions caused through forced penetration can facilitate entry of the virus.

Violence, or fear of violence, also makes it difficult for women and girls to disclose their HIV status and access essential HIV prevention, care, and treatment services. Women may also avoid HIV testing due to fears of violence and abandonment in a resulting discovery of HIV-positive status.

As noted by Dr. Claudia Garcia-Moreno, from WHO’s Department of Reproductive Heatlh and Research and Coordinator of the WHO Multi-country Study on women's health and domestic violence, “Violence against women is a fundamental violation of human rights and is often fueled by longstanding social and cultural norms that reinforce its acceptability in society – by both men and women. But there are concrete steps we can take in the AIDS and development responses to address violence, thereby dramatically improving women’s health and quality of life”.

Behaviour and societal change

According to participants at the consultation, policies and programmes addressing gender inequality and gender-based violence will help achieve universal targets to HIV prevention, treatment and care. Investment in responses in these areas is an essential part of HIV programming.

“Long-term interventions which address structural factors, gender inequalities and harmful gender norms, are essential if one is to reduce violence against women and HIV,” said Kristan Schoultz, Director of the Global Coalition on Women and AIDS. “At the same time there is also a need to move forward urgently to achieve shorter-term gains such as enhanced voluntary counselling and testing services and the provision of comprehensive post-rape care that addresses the psychological and physical health needs of sexual violence survivors”.

Participants believe that a “mosaic” of action addressing both long-term and short-term needs related to violence and HIV has the potential to have an impact upon not only MDG 6 (HIV), but all the health MDGs, including reduction of maternal mortality and achievement of sexual and reproductive health and rights; in addition, this approach is at the heart of MDG 3 (gender equality and empowerment of women) and MDG1 (poverty reduction).

The outcomes and recommendations from the meeting will feed into ongoing national and global advocacy efforts such as those of the Global Coalition on Women and AIDS, the UN Secretary General's Campaign for the Elimination of Violence against Women, and the Africa-Wide Campaign for the elimination of Violence against Women. Recommendations will also assist national AIDS authorities to better address the intersections between HIV and violence in national programming.

In a landmark report on the health of women and girls across the globe, the World Health Organization (WHO) states that AIDS-related illness is the leading cause of death and disease among women of reproductive age in low and middle income countries, particularly in Africa. Also, globally, unsafe sex is the single leading risk factor contributing to deaths among women of reproductive age. These findings support the contention in Women and Health: Today’s Evidence, Tomorrow’s Agenda that in a multiplicity of areas female health is neglected and must now be considered an urgent priority

The report maintains that women and girls are especially vulnerable to HIV infection due to a variety of biological and social factors. These include low socio-economic status that can limit choices and lead to high risk behaviours and norms and laws that subjugate women and which discourage them from seeking and obtaining the information they need to keep themselves safe. For example, globally only 38% of young women are able to describe the main ways to avoid infection and they are less likely to know that condoms can protect against HIV than young men. Data from 16 countries in sub-Saharan Africa from 2001-2007 also show that HIV prevalence is generally higher among adolescent girls aged 15-19 than their male counterparts. A significant cause of this is young girls partnering with older men who are more sexually experienced and more likely to be infected.

Violence against women

Violence against women is also a major cause of their increased vulnerability to HIV. It can make it difficult or impossible for them to control their sexual lives, abstain from sex or get their partners to use condoms. Violence, or the threat of it, can also result in women avoiding HIV prevention, treatment, care and support services.

For UNAIDS, this is a major area of concern and its Outcome Framework 2009-11 has stopping violence against women and girls as one of nine priority areas. According to Michel Sidibe, Executive Director of UNAIDS, “‘We know that there is a strong relationship between violence against women and HIV. We need to help young people develop the skills for mutual consent in sex and marriage and put an end to violence and sexual coercion. This is key to preventing HIV and to achieving gender equality in all aspects of life.”

Gender inequalities

Women and Health has an extremely broad scope and addresses a range of women’s health issues. The factors that come into play to increase women’s vulnerability to AIDS are also shown to profoundly affect women and girls’ general health and well-being. As the report contends, gender inequalities in the allocation of resources such as education, income, health care, nutrition and having a political voice are very much associated with poor health and reduced well-being.

“Despite considerable progress over the past two decades, societies are still failing women at key moments in their lives,” says Dr Margaret Chan, WHO Director-General, in the foreword to Women and Health. “These failures are most acute in poor countries, and among the poorest women in all countries. Not everyone has benefited equally from recent progress and too many girls and women are still unable to reach their full potential because of persistent health, social and gender inequalities and health system inadequacies.”

Key stages relevant for health: early childhood, adolescence, adulthood and older age

The report explores the lives of women and girls through key stages relevant for health: early childhood, adolescence, adulthood and older age, and shows that women face “widespread and persistent inequities” during each of these stages. It not only highlights women’s health needs- and how they are not being currently met in terms of HIV and other areas- but also the valuable contribution that they make to the health sector and society in general.

By using today’s evidence, sharing what is currently known about the health of women from all regions and throughout their lives, the report attempts to set out tomorrow’s agenda, a key element of which is championing reforms to enable women to not only be seen in their sexual and reproductive capacity, but to become active agents in health-care provision, playing a central role in the design, management and delivery of health services.

Women and Health draws attention to four areas where policy action could make a real difference to women’s health: building strong leadership and a coherent institutional response coalescing around a clear agenda; making health systems work for women; leveraging changes in public policy to encourage fundamental social change (through, for instance, targeted action to help girls enrol in school); and finally, building the knowledge base and monitoring progress.

WHO hopes that by reviewing the available data and charting a cogent way forward that the health of women and girls, and society as a whole, can be ameliorated. As the report has it, “Improve women’s health, improve the world.”

(from right) Executive Secretary of the UN Economic Commission for Africa Mr Abdoulei Janneh and Executive Director of UNAIDS Michel Sidibé, 9 November 2009.
Credit: UNAIDS

The Executive Director of UNAIDS Michel Sidibé met with the Executive Secretary of the Economic Commission for Africa (ECA) Mr Abdoulei Janneh earlier today in Addis Ababa, Ethiopia.

They held broad-ranging discussions on the relationship between health and development and the need to find innovative ways to generate financial resources to fund future HIV treatment for people in need. The importance of resource monitoring and evaluation of results for the Millennium Development Goals was also underlined.

Mr Abdoulei Janneh also updated Mr Sidibé on the Coalition for Dialogue in Africa (CoDA) which was launched earlier this year as a joint venture between the African Development Bank and the ECA to stimulate discussions on African socioeconomic issues and explore new ways for Africa development.

(from left) Executive Director of UNAIDS Michel Sidibé and the Executive Secretary of the UN Economic Commission for Africa Mr Abdoulei Janneh held discussions on health financing, 9 November 2009.
Credit: UNAIDS

The CoDA initial advisory board includes Dr Frene Ginwala, Former Speaker of the National Assembly of South Africa; Mr Mo Ibrahim, Chair, Mo Ibrahim Foundation; Dr. Spciosa Wandira Kazibwe, former Vice President of the Republic of Uganda; and The Right Honourable, Mr. Paul Martin, former Prime Minister of Canada.

While in Addis this week Mr Sidibé is attending the board meeting of the Global fund to Fight AIDS, TB and Malaria.

(from left): UNIFEM Regional Director East and South East Asia, Dr Jean D’Cunha; UNAIDS Director of the Asia Pacific Regional Support Team, Prasada Rao; Executive Director of the ASEAN Foundation, Filemon Uriarthe Jr; and APN+ Regional Coordinator and Director, Shiba Phurailatmam.
Credit: UNAIDS

Studies in Asia indicate that most women in the region acquire HIV because of their partners who engage in unsafe behaviours. It is estimated that more than 90% of women living with HIV acquired the virus from their husbands or boyfriends while in long-term relationships. An effective AIDS response must address intimate partner relationships to prevent HIV infections in the female partners of men with high-risk behaviours.

In an effort to fill this gap in the AIDS response, UNAIDS and the ASEAN Foundation signed an agreement in Bangkok to support work on gender and HIV in the Asia Pacific region.

The partnership began in 2007 when the United Nations Development Fund for Women (UNIFEM) and UNAIDS joined hands with the ASEAN Foundation in order to strengthen joint work on the gender aspects of HIV.

In 2008 the partnership expanded to include the United Nations Development Programme (UNDP); the Asia Pacific Network of People Living with HIV/AIDS (APN+); the Coalition of Asia Pacific Regional Networks on HIV/AIDS, also known as the Seven Sisters, and the International Community of Women with HIV/AIDS (ICW). The partnership at country and regional levels also included researchers, civil society, people living with HIV and national AIDS commissions.

The agreement, which cements this commitment further, was signed in the presence of UNAIDS Director of the Asia Pacific Regional Support Team, Prasada Rao; Executive Director of the ASEAN Foundation, Filemon Uriarthe Jr; UNIFEM Regional Director East and South East Asia, Dr Jean D’Cunha; and APN+ Regional Coordinator and Director, Shiba Phurailatmam.

Speaking on the occasion, Mr Rao said, “The project is not only to understand what needs to be done but to pave the way to programmes that work on the ground.” He added that a range of strategies was needed, including scaling up efforts with key populations at risk in urban areas and through reproductive health programmes for rural women.

Dr D’Cunha stressed the importance of working on gender power dynamics, especially for positive women whose voices must be heard. “All the issues are interconnected and cannot be tackled by any one agency,” he said.

Mr Phurailatham stressed the need to approach women who are considered “low-risk” through their “high-risk” partners. He also stated that it was all the more important that laws criminalizing HIV were changed, as "laws that hamper HIV prevention, criminalize those men at risk can only have a negative impact on the lives of those women."

According to the agreement, funding from the ASEAN Foundation will be leveraged to aid the resources provided through UNAIDS, UNIFEM and UNDP.

HIV and Intimate Partner Relationships

In July this year representatives of AIDS commissions, UNICEF, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria and 90 delegates from 15 Asian countries unanimously agreed that intimate partner relationships had to be included in national HIV policies and programmes. A report titled HIV Transmission in Intimate Partner Relationship in Asia was an outcome of this unanimous decision.

The report recommends that HIV prevention interventions be scaled-up for men who have sex with men, injecting drug users and clients of female sex workers. It also suggests that structural interventions should be initiated to identify and address the needs of vulnerable women and their male sexual partners.

UNAIDS Executive Director, Mr Michel Sidibé took part in a meeting earlier this week organized by the Netherlands Multi Party Initiative on HIV/AIDS. The meeting was co-organized by the Dutch NGOs “STOP AIDS NOW!” and Aids Fonds under the banner AIDS in a Time of Financial Crisis, to explore together how to face the challenges posed by the global financial crisis.

The event was opened by the Dutch AIDS Ambassador Marijke Wijnroks.

Speaking at the meeting, Mr Sidibé congratulated the Netherlands for their outstanding leadership and stressed the key role the country is playing in the global AIDS response.

“We see the Netherlands as a strong likeminded partner. Together we have achieved much in the battles against discrimination and forwarding the human rights agenda,” said Mr Sidibé.

“But for every 2 persons who are placed on antiretroviral treatment, 5 people are newly infected – we look forward to a continued strong relationship with the Dutch government to break the trajectory of the epidemic,” Mr Sidibé asserted.

Also participating in the meeting was the Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight TB, Malaria and HIV, Mr Ewout Irrgang, chair of the Multi Party Initiative and Mrs Kathleen Ferrier, vice chair for the Multi Party Initiative.

The Netherlands Multi Party Initiative on HIV/AIDS consists of members of parliament across party lines in the Dutch Parliament. It was established in February 2007 by Kathleen Ferrier, MP.

The primary goal of this informal network is to ensure HIV as well as sexual and reproductive health and rights and related issues are kept on the agenda. The group also raises awareness at the national, regional and international level through the Dutch Parliament, the Council of Europe and the European Parliament.

People living with HIV who are following an effective antiretroviral therapy regimen can achieve undetectable viral loads – the amount of virus in a body fluid such s blood, semen or vaginal secretions – at certain stages of their treatment. Research suggests that when the viral load is undetectable in blood the risk of HIV transmission is significantly reduced. However, antiretroviral therapy for prevention has not proven to completely eliminate the risk of transmitting the virus.

To explore the issue WHO earlier this week convened a meeting to review the scientific data available on the use of ART for prevention and also explored the implications of this approach for individuals and communities as well as take into consideration human rights and ethical and public health implications.

Participating in the meeting, UNAIDS Deputy Executive Director, Dr Paul De Lay, provided closing reflections. Dr De Lay said the meeting had raised the hard fact that many people living with HIV - including many who need treatment today - are unable to access HIV testing and counseling and to initiate timely treatment, as a result of a range of social, cultural and economic barriers.

Dr De Lay congratulated the participants in their effort to identifying scientifically sound and innovative ways to accelerate progress toward universal access to HIV prevention, treatment, care and support, and maximizing the effects of ART both for extending full and productive life for people with HIV, and also for primary prevention.

"These are exciting and challenging times. The diverse perspectives heard in this meeting reflect the best of the AIDS response, and continuing this dialogue - this committed questioning and the research agenda coming from this meeting - will undoubtedly lead to more lives saved and fewer new infections" continued Dr De Lay.

UNAIDS strongly recommend a comprehensive approach to HIV prevention that plans and delivers an evidence informed and human rights based combination of programmes and policies, tailored to meet the needs of those most at risk, and including practical programmes to reduce underlying causes of vulnerability, such as gender inequality and HIV related stigma and discrimination. 

Antiretroviral therapy will play several roles in combination prevention strategies, along with other key strategies including, but not limited to, social and behavioral change communication to delay sexual debut, promote mutual fidelity and reduction of the number of sexual partners, promote safer sex including correct and consistent male and female condom use, harm reduction programmes for people who use drugs, prevention of vertical transmission, and other biomedical, behavioural and structural prevention programmes. 

The WHO hosted antiretroviral treatment (ART) for Prevention was held in Geneva from the 2 to the 4 of November, 2009.

(from left) President of South Africa, Jacob Zuma; UNAIDS Executive Director, Michel Sidibé; and Minister of Health South Africa, Dr Aaron Motsoaledi meet at the opening of the UN General Assembly in New York, 24 September 2009.
Credit: UNAIDS

South Africa’s response to AIDS received a powerful boost with President Jacob Zuma’s landmark speech to the National Council of Provinces on 29 October 2009. The speech heralds the beginning of a new movement to accelerate access towards universal access to HIV prevention, treatment, care and support in the country which has the largest number of people living with HIV. In his speech the President calls on all leaders to work together and use evidence to inform the country’s AIDS response.

Congratulating the President on his bold leadership, UNAIDS Executive Director Michel Sidibé said, “President Zuma has shown extraordinary vision in prioritizing AIDS as an issue of national importance. His call to end denialism and embark on a national mobilization campaign will saves thousands of lives.”

In his speech the President called for a major movement to cut new HIV infections by half and reach at least 80% access to antiretroviral treatment. UNAIDS will support the Government of South Africa in implementing this promise.

Here are some excerpts from speech of President Zuma of South Africa to the National Council of Provinces.

The full speech can be accessed online

“Our young democracy faces significant challenges. Though we have achieved much, there is much more that we need to do. Just as we cannot allow ourselves to be overwhelmed by these challenges, we dare not underestimate them. If we are to build the thriving nation for which we have worked so hard, and for which so many have sacrificed so much, we need to appreciate the extent and nature of these challenges.

I would like to highlight two critical challenges, both of which, in different ways, have the potential to undermine our efforts to achieve a better life for our people.

The first of these challenges relates to our economy. The global economy is going through a major economic crisis. The impact of this crisis has been felt by every section of our society. Businesses, both big and small, have been closed. Thousands of workers have lost their jobs. As more families lose their livelihoods and businesses risk collapse, they look to government for assistance….”

“The second challenge that I wish to highlight is no less grave. Indeed, if we do not respond with urgency and resolve, we may well find our vision of a thriving nation slipping from our grasp.

Recent statistics from the Department of Health, Human Sciences Research Council, Medical Research Council, Statistics SA and other sources paint a disturbing picture of the health of our nation. They show that nearly 6 out 10 deaths in our country in 2006 were deaths of people younger than 50 years. If we consider mortality trends over the last decade, we see that the age at which people die has been changing dramatically. More and more people are dying young, threatening even to outnumber in proportional terms those who die in old age.

Honourable Members, South Africans are dying at an increasing rate. The number of deaths registered in 2008 jumped to 756,000, up from 573,000 the year before.

At this rate, there is a real danger that the number of deaths will soon overtake the number of births. The births registered during this period were one million two hundred and five thousand one hundred and eleven (1, 205, 111). The Independent Electoral Commission had to remove 396 336 deceased voters from the Voters Roll during September last year and August this year.

What is even more disturbing is the number of young women who are dying in the prime of their life, in their child-bearing years. In 2006, life expectancy at birth for South African men was estimated to be 51 years. By contrast, life expectancy in Algeria was 70 years and 60 years in Senegal. These are some of the chilling statistics that demonstrate the devastating impact that HIV and AIDS is having on our nation.

Not even the youngest are spared. Some studies suggest that 57% of the deaths of children under the age of five during 2007 were as a result of HIV. This situation is aggravated by the high tuberculosis prevalence. The co-infection rate between HIV and TB has now reached a staggering 73%. Statistics indicate that the numbers of citizens with TB number at 481 584. These statistics do not, however, fully reveal the human toll of the disease. It is necessary to go into the hospitals, clinics and hospices of our country to see the effects of HIV and AIDS on those who should be in the prime of their lives.

It is necessary to go into people’s homes to see how families struggle with the triple burden of poverty, disease and stigma. Wherever you go across the country, you hear people lament the apparent frequency with which they have to bury family members and friends.

Let me emphasize that although we have a comprehensive strategy to tackle HIV and AIDS that has been acknowledged internationally, and though we have the largest anti-retroviral programme in the world, we are not yet winning this battle. We must come to terms with this reality as South Africans.

We must accept that we need to work harder, and with renewed focus, to implement the strategy that we have developed together. We need to do more, and we need to do better, together. We need to move with urgency and purpose to confront this enormous challenge.

If we are to stop the progress of this disease through our society, we will need to pursue extraordinary measures. We will need to mobilize all South Africans to take responsibility for their health and well-being and that of their partners, their families and their communities.

All South Africans must know that they are at risk and must take informed decisions to reduce their vulnerability to infection, or, if infected, to slow the advance of the disease.

Most importantly, all South Africans need to know their HIV status, and be informed of the treatment options available to them. Though it poses a grave threat to the well-being of our nation, HIV and AIDS should be treated like any other disease. There should be no shame, no discrimination, no recriminations. We must break the stigma surrounding AIDS.

In just over a month, we will join people across the globe in marking World Aids Day. Let us resolve now that this should be the day on which we start to turn the tide in the battle against AIDS. Let us resolve now that this should be the day on which we outline those additional measures that need to be taken to enhance our efforts.

Let World Aids Day, on the 1st of December 2009, mark the beginning of a massive mobilisation campaign that reaches all South Africans, and that spurs them into action to safeguard their health and the health of the nation. Though a considerable undertaking, it is well within our means, and we should start now, today, to prepare ourselves for this renewed onslaught against this epidemic.

We have very impressive awareness levels in our country, well over 95%. We should now seriously work to convert that knowledge into a change of behaviour. We have demonstrated in the past that, working together as a nation, we can overcome even the greatest of challenges. We can and will overcome this one.

But we must begin by acknowledging the true nature of that with which we are confronted. We should not be disheartened by what we find. Rather, we should be encouraged to act with greater energy and motivation to overcome.

I have instructed the Minister of Health, as we prepare for World Aids Day, to provide further detail to the nation on the impact of HIV and AIDS on our people. He will do so next week.

The important factor is that our people must be armed with information. Knowledge will help us to confront denialism and the stigma attached to the epidemic.

Informed by this understanding, we expect that the South African National AIDS Council, under the leadership of the Deputy President of the Republic, Mr Kgalema Motlanthe, will develop a set of measures that strengthen the programmes already in place. We must not lose sight of the key targets that we set ourselves in our national strategic plan.

These include the reduction of the rate of new infections by 50%, and the extension of the antiretroviral programme to 80% of those who need it, both by 2011. Prevention remains a critical part of our strategy. We need a massive change in behaviour and attitude especially amongst the youth. We must all work together to achieve this goal.

As we prepare for World Aids Day, and as we undertake the programmes that must necessarily follow, let us draw on our experience of mass mobilization and social engagement. The renewed energy in the fight against AIDS and in mobilizing towards World Aids Day must start now, by all sectors of our society. Working together, we cannot fail.

Whatever challenges we face, we will overcome. Whatever setbacks we endure, we will prevail. Because by working together we can and will build a thriving nation.

Geneva/New York, 31 October 2009 — UNAIDS welcomes President Obama’s announcement of the final rule removing entry restrictions based on HIV status from US policy.  The removal of HIV-related travel restrictions in the US overturns a policy that had been in place since 1987. Such restrictions, strongly opposed by UNAIDS, are discriminatory and do not protect public health.

“I congratulate President Obama on announcing the removal of the travel restrictions for people living with HIV from entering the United States,” said United Nations Secretary-General Ban Ki-moon. “I urge all other countries with such restrictions to take steps to remove them at the earliest.”

The United Nations Secretary-General has made the removal of stigma and discrimination faced by people living with HIV a personal issue. He called for the removal of travel restrictions for the first time in his address to the General Assembly during the High Level Meeting on AIDS in 2008. “That they should be discriminated against, including through restrictions on their ability to travel between countries, should fill us all with shame,” said Secretary-General Ban in a speech to the Global AIDS Conference in August last year.

At his request, several countries including his home country, the Republic of Korea, are in the last stages of removing travel restrictions. Other countries that are considering removal of travel restrictions include China and Ukraine. In 2008, the UNAIDS board strongly encouraged all countries to eliminate HIV-specific restrictions on entry, stay and residence and ensure that people living with HIV are no longer excluded, detained or deported on the basis of HIV status.
“Placing travel restrictions on people living with HIV has no public health justification. It is also a violation of human rights,” said Michel Sidibé, Executive Director of UNAIDS. “We hope that other countries that still have travel restrictions will remove them at the earliest.”

Nearly 59 countries impose some form of travel restrictions on people living with HIV. The International Guidelines on HIV/AIDS and Human Rights state that any restriction on liberty of movement or choice of residence based on suspected or real HIV status alone, including HIV screening of international travellers, is discriminatory. Travel restrictions do not have an economic justification either. People living with HIV can now lead long and productive working lives, a fact that modifies the economic argument underlying blanket restrictions; concern about migrants’ drain on health resources must be weighed with their potential contribution.