“Circle in the sun” from The House is Small but the Welcome is Big exhibition
Credit: www.thehouseissmall.org/Aires

On 17 November UNAIDS hosted a reception for the opening of an exhibition at the United Nations in New York entitled The House Is Small But The Welcome Is Big, a project of the Los Angeles–based Venice Arts of over 40 extraordinary photographs made by South African women living with HIV and Mozambican children who lost both parents to AIDS.

The exhibit, which runs until 11 December, sheds light on the hopes and aspirations of people affected by the epidemic, as well as the discrimination and stigma associated with HIV.
Accompanied by biographical panels, the exhibit conveys the daily lives of 15 women and 18 children who face tremendous challenges because of HIV. The photos are simultaneously stark and hopeful, lively and compelling. Some are difficult to look at. All of them are hard to dismiss.

Bertil Lindblad, Director of the UNAIDS New York Office, said that the exhibit evokes the words of United Nations Secretary-General Ban Ki–moon: “HIV is about everyone. It is not about ‘us versus them’.  There is no ‘them’ – only ‘us’, together.”  The exhibit is one of many events worldwide commemorating World AIDS Day on 1 December.

“The Mozambican handshake” from The House is Small but the Welcome is Big exhibition
Credit: www.thehouseissmall.org/Farida

Neal Baer, M.D., Emmy-nominated writer/executive producer of the television series Law & Order: Special Victims Unit and a co-founder of the project, commented “These women and children have a lot to say through these images about living on their own and raising younger siblings by themselves,” said Baer. “That’s the harsh truth about AIDS. Millions of children are growing up without the guidance or love of one or both parents, with many carrying parental responsibilities.” Law & Order: Special Victims Unit star Stephanie March joined Dr Baer at the event.

Also attending the reception was Ambassador Baso Sangqu, Permanent Representative of South Africa to the United Nations.

The name of the exhibition comes from one of the photographs taken by 28 year-old Funeka Nceke of Cape Town. On the wall of her friend’s home hangs an embroidered cloth that reads, “The House Is Small But the Welcome Is Big.” Funeka lives in a shack with no electricity or running water with her two children and two additional family members.

One beautiful photograph titled “My Memories” shows a pair of hands gently touching old black and white photographs.  “Photographs of my parents are displayed, which show their past. I show everyone my parents [when they were] alive through these photos, which is a joy for me,” says Joaquim Macamo, the 16 year-old photographer. Macamo lost both of his parents to AIDS in 2001 and lives with his 20 year-old sister.

The exhibit has been featured at venues around the world, including New York City; Los Angeles, Oakland, and Palo Alto, CA; Boston, MA; Colorado Springs and Denver, CO; Tallahassee, FL; Maputo, Mozambique; Toronto, Canada; Mexico City, Mexico; and Paris, France.

Award–winning Venice Arts has run innovative programs in documentary photography, filmmaking, and digital media/arts since 1993. The organization also implements participant-produced photo documentary projects with adults and children, and co–directs the Institute for Photographic Empowerment in collaboration with the University of Southern California Annenberg Center for Communication Leadership.

His Serene Highness Prince Albert II of Monaco (right) awards UNAIDS Executive Director Michel Sidibé the Order of Saint Charles. Monaco, 18 November 2009.
Copyright: G. Luci-Palais Monaco

UNAIDS Executive Director Michel Sidibé was awarded the Order of Saint Charles along with UNESCO Director-General Koïchiro Matsuura in the Principality of Monaco during the country’s National Day.

The order rewards merit and service to the state or Prince of Monaco and is one of the country’s most prestigious distinctions.

The medal was awarded in the presence of His Serene Highness Prince Albert II of Monaco, Her Royal Highness Princess Caroline of Hanover and Her Serene Highness Princess Stéphanie.

Expressing his appreciation for the award, Mr Sidibé emphasized the importance of Monaco’s efforts in the response to the AIDS epidemic, noting Monaco’s financial contribution to the response in priority countries Madagascar and Burundi and the personal commitment of the royal family.

Her Serene Highness Princess Stéphanie, Goodwill Ambassador for UNAIDS, has been working with the organization since 2006 focusing on HIV prevention and raising awareness on the impact of discrimination against people living with HIV.

Mr Sidibé praised the leadership of Her Serene Highness in her work to increase the visibility of issues related to AIDS.

During his last visit to the country in May 2009, Mr Sidibé renewed the existing funding agreement between UNAIDS and Monaco until 2011.

State of the Worlds Population, 2009
Credit: UNFPA

The success of the global response to AIDS will rely on tackling not only the encroaching virus itself but also the affects of climate change such as food and water shortages, growth in poverty and an increase in natural disasters, argues the State of World Population 2009, released today by the United Nations Population Fund (UNFPA).

The report also contends that, equally, strengthening the response to the AIDS epidemic will mean that individuals, communities and societies will have greater social resilience in the face of a range of climate change threats and will be better able to deal with their consequences. HIV and climate change are perceived as profoundly linked, a perception shared by a range of UN bodies, including UNAIDS and the United Nations Environment Programme, UNEP.

Subtitled, ‘Facing a changing world: women population and climate’, The State of World Population places women at the very centre of the attempt to confront climate change and maintains that policies, programmes and interventions are more likely to mitigate its worst effects if they reflect the rights and needs of women.

Women are said to bear the brunt of climate change, partly because in many countries they make up the majority of the agricultural workforce hard hit in an environmental crisis, and because they often do not have sufficient control of their lives and access to as many opportunities to generate income as men – they are more likely to be poor and to see their poverty increase. As UNFPA Executive Director Thoraya Ahmed Obaid has it, “Poor women in poor countries are among the hardest hit by climate change, even though they contributed the least to it.”

Numerous examples of extreme climate change are cited, from melting glaciers in Bolivia, to the destruction of crops by typhoons in the Philippines, and from drought in east and southern Africa to floods in Vietnam. In each scenario, women are shown struggling to keep their livelihoods and families intact, and, in some cases, fighting for their lives.

According to the report, empowering women and girls, especially through investments in health and education, help boost economic development and reduce poverty, thus having a beneficial impact on coping with climate change. Girls with more education are more likely to protect themselves against HIV and to have smaller and healthier families as adults. In general, access to reproductive health services such as family planning means lower fertility rates and this has a clear bearing on lessening the potential impact of environmental crises and making sustainable development more likely.

“Women should be part of any agreement on climate change—not as an afterthought or because it’s politically correct, but because it’s the right thing to do,” says Ms Obaid. “Our future as humanity depends on unleashing the full potential of all human beings, and the full capacity of women, to bring about change.”

The State of World Population 2009 argues that ensuring gender inequity is challenged in all its facets is an urgent necessity, not just to improve the lives of individual women but to stave off the worst consequences of environmental crisis. This sense of urgency is relayed to the leaders and negotiators due to meet in Copenhagen for December’s critical climate change conference. They are urged to “think creatively” not just about emissions and targets but about population, reproductive health and gender equality and how they can contribute to “a just and environmentally sustainable world.”

Yulia Lasker, Russian singer, who purchased a tapestry at the opening of the exhibition.
Credit: UNAIDS

UNAIDS and the All-Russian Union of People Living with HIV came together for the second time to support the international project Art Against AIDS that unites well-known artists in the response to the HIV epidemic in Russia. This year, proceeds from the sale of art at the exhibition went to low-income families raising children living with HIV.

More than 30 contemporary artists, photographers, and musicians from Russia, the United States, Japan, Greece and Spain offered their work for the charitable exhibition-sale held at the Central House of Artists from 12 - 26 November 2009. Last year, funds raised during the exhibition-sale went to children living with HIV at the Vsevolozhsk Orphanage in Leningrad Oblast.

There is increasing political and financial commitment for universal access to HIV prevention, treatment and care in Russia, even in the face of a global financial crisis. The country is set to increase the number of people on antiretroviral treatment by 50,000 in 2009. Through this exhibition, artists, photographers and musicians are helping to speak openly about HIV and to draw the attention of the wider public towards this issue.

One of the art pieces sold at the launch of Art Against AIDS on the 12 of November.
Credit: UNAIDS

Earlier in October during the 3rd HIV/AIDS Conference in Eastern Europe and Central Asia, UNAIDS Executive Director Michel Sidibé said that there has been progress in the region with many countries set to achieve universal access target goals. But the UNAIDS head also noted that the AIDS epidemic continues to outpace the response as the estimated number of adults and children living with HIV in the Eastern Europe and Central Asia region has doubled since 2001.

Injecting drug use is the main mode of HIV transmission across Eastern Europe and Central Asia. HIV prevention among drug users and their sexual partners is a vital component of an evidence-informed response. Although the HIV epidemic in the Russian Federation is the largest in the region, there are rising numbers in Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Tajikistan, and Uzbekistan.

New campaign to be broadcast by television across Brazil highlights rights of students, gay men, lesbians, people living with HIV, the Afro-Brazilian population, sex workers, refugees, transsexuals and transvestites and drug users.

Equal rights and a call to Brazilian society on the issue of the discrimination experienced daily by men, women and children in the country are the messages of a powerful ”Just like you” video campaign, launched 16 November in Rio de Janeiro, by UNAIDS in partnership with other United Nations agencies with the participation of civil society and the government authorities on human rights.

Ten thirty second films were shown during the launch, films that present a panorama of the reality faced by each population covered by the campaign – school students, gay men, lesbians, people living with HIV, the Afro-Brazilians, sex workers, refugees, transsexuals and transvestites and drug users. The films will be broadcast in Portuguese on television stations throughout the country. DVDs and CDs will also be distributed to health care facilities, schools and the National Business Council on HIV. The films are also available with subtitles in English and Spanish so they can be shown internationally.

The campaign launch ceremony was followed by a press conference, at the Palácio do Itamaraty with the community leaders who recorded the campaign messages as well as UN officials from UNODC, UNAIDS, UNIFEM, UNESCO, UNHCR and UNIC. Representatives of the Special Secretariats of Human Rights and of Policies in Promotion of Racial Equality, the Ministry of Education and civil society were also present.

“Just like you, I want respect,” still from one of the videos in the “Just like you” campaigne launched in Rio de Janeiro on 16 November, 2009.
Credit: UNAIDS

Human rights visibility

“Just like you” is a campaign against stigma and prejudice, giving voice and visibility to the human rights of people often overlooked by society in Brazil. The films communicate the messages of leaders of each of the discriminated groups.

The campaign is an initiative against human rights violations and inequalities in the areas of health, education, employment, public security and everyday life. It is an opportunity to raise the awareness of Brazilian society with regard to respecting the differences that characterize each of the social groups represented in the campaign, reaffirming equal rights.

Everyday stigmas and prejudices

Data from the Brazilian Institute of Geography and Statistics reveal the racial and gender inequalities in Brazil through the disparity in average monthly income: white men earn on average R$ 1,200, considerably more than white women (R$700), twice that of black men (R$ 600), and three times that of black women (R$ 400).

The school environment is another example of resistance to diversity. A 2009 survey of 500 state schools done by Anísio Teixeira National Institute of Educational Research and Studies and Economic Research Institute Foundation, between 55% and 72% of students, teachers, head teachers and education workers showed a resistance to diversity and the greatest distance was seen in relation to homosexuals (72%).

Campaign signature

Prejudice manifests itself through discriminatory attitudes and practices, such as humiliation, aggression and unfair accusations merely because people belong to a specific social group.

The United Nations agencies in Brazil joined with a number of civil society groups for this equal rights campaign including ABGLT (Brazilian Gay, Lesbian, Bisexual, Transvestite and Transsexual Association), AMNB (Association of Black Brazilian Women), ANTRA (National Articulation of Transvestites, Transsexual and Transgender Persons), the Brazilian Movement of People Living with HIV/AIDS and the Brazilian Network of Prostitutes.

The World Summit on Food Security opens 16 November in Rome. In many parts of the world, lack of food security and poor nutrition are worsening the effects of the HIV epidemic.

Although HIV testing is increasingly available and efforts to support the nutritional needs of people living with HIV have intensified appreciably, antiretroviral therapy (ART) service providers continue to report large numbers of clients presenting with advanced disease and acute malnutrition. In some ART programmes, as many as 33 percent of all first-visit clients are unable to walk into the clinic without assistance, correlating with high rates of mortality in the first 90 days of treatment. In response, there has been a rapid proliferation of Food by Prescription (FBP) programmes, designed to ensure efficient and effective nutrition care and rehabilitation for people enrolled in HIV care and treatment programmes.

This paper from the Global Alliance for Improved Nutrition (GAIN) provides an overview of current thinking on modes of delivery and the salient issues surrounding FBP programme implementation. Its purpose is to document current thinking and experience, and identify areas of convergence and divergence. This will provide a starting point for future consultations where key issues can be elaborated and prioritized, and a plan for future action developed. Given the dearth of literature on FBP, information for this report was gathered primarily through semi-structured interviews with key informants from governments, civil society organizations, technical assistance agencies, donors and beneficiary groups.

This document reveals that, in less than a decade, a wide variety of creative FBP mechanisms and designs have emerged, catering to one or more of three core objectives. The primary emphasis of FBP programmes is on the nutritional rehabilitation and/or nutrition support of the patient to improve well-being and treatment outcomes. However, many FBP programmes have expanded this mandate to include provision of social safety nets to support treatment adherence and protect household integrity. Moreover, several FBP programmes have begun to support livelihood activities with the aim of encouraging a productive recovery and sustaining adherence. Programme designs are highly contextualized: some focus on one or two of these objectives while others aim for a comprehensive approach through partnerships and referral networks. Some programmes operate from a clinical base while others operate from an established foothold in the community, while still others have formed strategic linkages which span home, community and clinical settings.

Among all those interviewed, there is a sense of urgency driving the rapid rollout of this programming and an acknowledgement that there is much to learn about how to do it well. There is (at this point) no consensus about the optimal location of FBP programmes. There is general agreement on the use of anthropometric criteria for programme entry, but less agreement on discharge criteria. There are several different commodity options in use, with no evidence base to guide decision-making. In many settings, there is a need to more clearly differentiate between client-level nutritional rehabilitation and household-level food insecurity. There is a call for guidance and harmonization of objectives, standards and protocols.

This document was constructed according to themes, which were identified early in the process.

These included potential for integration and standardization; allocation of resources; human resource requirements and challenges; commodity management; wraparound services; monitoring and evaluation; the beneficiary perspective and the long-term outlook. The report closes with a summary of common issues and a preliminary list of issues for follow-up

Participants of the Study Tour in Kolkata with staff and Board Members of the NGO, SCIR.

National police officers and National AIDS Programme heads from Cambodia, Maldives, Mongolia, Philippines, and Sri Lanka visited India last mnth to get a firsthand experience of law enforcement initiatives on interventions related to high risk populations.

Organised by the UNAIDS India office with support from the Regional Support Team of Asia-Pacific, the 16 participants visited and interacted with programme staff of police-initiated and supported projects in Kolkata and New Delhi. The purpose of the Study Tour was to learn the approaches of and lessons learned from law enforcement efforts for sex workers and injecting drug users and their vital role in creating a supportive environment for HIV interventions.

In Delhi, the participants visited Shakti Vahini, a non-governmental organization (NGO) working with sex workers on GB Road, one of Delhi’s oldest red light areas. Personal interactions with sex workers provided them with first-person stories of the realities of brothel-based sex work and the relationships the workers have built with the district police. The Tihar Prison, India’s largest prison, showcased the prison’s innovative and comprehensive programme for recovering injecting drug users, a model programme now being promoted in other prisons in India.

The Toll-free Hotline run by the Central Reserve Police Force (CRPF) - which has a national workforce of a million workers – was of great interest to the group. With the assistance of software developed especially for the project, the Hotline takes calls from police personnel from all parts of India on HIV, sexually transmitted infections, drug and substance abuse and provides addresses of counselling centres and welfare schemes of CRPF. The Helpline has responded to thousands of calls for information and for referrals to counselling services.

In West Bengal, the group travelled from Kolkata to Asansol, a large industrial town with a settlement of sex workers. The project DISHA Jana Kalyan Kendra began its work in 1995 with a collaboration with the district police force with the aim of improving the health and socio-economic conditions of sex workers in the town. In addition to providing health services, vocational and job skills training, and pre-school education for children of sex workers, DISHA has worked with the police in reducing criminality in the community.

In Kolkata, the Study Tour participants visited the NGO Society for Community Intervention and Research (SCIR) to observe their work with people who inject drugs (IDUs). The NGO works in the community of Tiljala, the largest slum settlement in Kolkata. It offers educational programmes for children, livelihood training for IDUs as well as an oral substitution treatment programme.

The projects covered in the Study Tour gave a novel perspective on the role of the police sector not only as law enforcers but also as community enablers. Given the legal and judicial frameworks in the countries represented by the participants, these innovations gave rise to challenges on how they may be replicated in their countries. The Study Tour, as a South-South learning opportunity, demonstrated encouraging prospects of police leadership to break new ground.

The Global Fund to Fight AIDS, Tuberculosis and Malaria’s Board of Directors has approved new grants with a two-year commitment of US$2.4 billion. The Global Fund Board concluded its 20th meeting in Addis Ababa, Ethiopia on 11 November. High on the agenda were discussions on the implications of the global financial crisis for a fully funded AIDS response.

The Global Fund Board also announced the launch its next round of grants in May 2010. This round of funding will be considered for approval at a Board meeting to be held some time between November 2010 and January 2011.

“We are seeing a tremendous demand for funding,” said Michel Kazatchkine, the Executive Director of the Global Fund. “Countries are showing that they are able to effectively turn large amounts of money from donors into prevention, care and treatment of AIDS, TB and malaria, which in turn will save millions of lives.”

Addressing the Global Fund Board earlier in the week UNAIDS Executive Director, Mr Michel Sidibé congratulated Dr Kazatchkine on the excellent progress made over the last year.

Mr Sidibé expressed concern that because overall resource demand is higher than anticipated in the funding scenario of the replenishment meeting in Berlin in 2007, the Global Fund risks facing a resource gap for the period 2009-2010. He reiterated his call to donor countries to ensure that the Global Fund is fully funded. He also called for appropriate prevention investments that match the nature of the epidemic, for example in Eastern Europe where HIV is mainly transmitted via injecting drug use.

Speaking on the potential impact of the financial crisis on the AIDS response, Mr Sidibé called for innovative approaches and the need to establish new partnerships in the AIDS response.

With its key approaches – country ownership, inclusiveness, accountability and performance-based funding – the Global Fund is setting the standard in development financing and is strongly aligned with aid effectiveness principles. Praising this approach, Mr Sidibé encouraged even greater engagement with implementing countries and communities in decision-making processes.

Mr Sidibé also committed to scaling up technical support from the UN system and that UNAIDS programme at the country and regional level would expand its support to the Global Fund.

“A strengthened partnership at country level will lead to greater cohesiveness and sustainability of the response,” said Mr Sidibé.

The Global Fund Board also approved a new grant architecture to simplify grant management and reporting by countries and facilitate their strategic, long-term planning.

The Global Fund was created in 2002 with a mandate to dramatically increase resources to fight three of the world's most devastating diseases – HIV, TB and Malaria, and to direct resources to areas of greatest need. It has since approved a total funding of US$18.4 billion for 144 countries. It’s a global public/private partnership between governments, civil society, the private sector and affected communities the Global Fund represents a new approach to international health financing.

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.