When AIDS first emerged in the 1980s, it mainly affected men. Today, according to UNAIDS figures, women account for about half of the 33 million people living with HIV worldwide, and 60 per cent of those infected in sub-Saharan Africa. Most of these women acquired the virus through heterosexual intercourse, often through unprotected sex with their husbands or long-term primary partners.

“Women think marriage is a safe haven,” says Beauty Nyamwanza of Zimbabwe’s National AIDS Council. “They think that when you’re married, you don’t have to worry about HIV.”

But what the AIDS-prevention team in the country found out is that marriage can actually increase the risk of HIV among young women. According to research carried out in Kenya and Zambia in 2004 , marriage increases the frequency of sex and hinders a woman’s ability to negotiate condom use or abstain from sex. Married women are often afraid to ask their husbands to use a condom – or to use one themselves – since this implies that they suspect their husbands of infidelity.

Thanks to the efforts of Ms Nyamwanza and others, Zimbabwe is one of a handful of countries that has taken advantage of the female condom and made major inroads in promoting its use. The latest device, the FC2, is a strong, flexible, nitrile sheath, about 17 centimetres (6.7 inches) long, with a flexible ring at each end. The closed end is inserted into the woman’s body, and the open end remains outside during intercourse. Like the male condom, it offers dual protection against unintended pregnancy and sexually transmitted infections, including HIV. But it has one critical advantage: it is the only available technology for HIV prevention that women can initiate and control.

Condom promoters in Zimbabwe suggest that married women can present the female condom as a means of child spacing. In this way, the issue of a woman appearing to accuse her husband of having other partners and putting her at risk need not arise.

Building support

Zimbabwe introduced the female condom in 1997, but acceptance was slow. Eventually, the Government requested support from the United Nations Population Fund (UNFPA) to scale up promotion of both male and female condoms through the public sector. Beyond training condom promoters, highly creative ways to educate the public about condom use were employed. Billboards, radio spots and TV commercials helped break down taboos against talking about condoms, and thus helped overcome the stigma sometimes associated with them. In the process of implementing the strategy, the team – which included the Ministry of Health and Child Welfare, the Zimbabwe National Family Planning Council, the National AIDS Council and Population Services International (PSI) – discovered that the female condom can be a tool for empowerment, enabling women and adolescent girls to take the initiative in protecting their own reproductive health and that of their partners.

From 2005, when the strategy was launched, to 2008, female condom distribution by the public sector in Zimbabwe increased five-fold, from about 400,000 to more than two million. Sales of female condoms through social marketing rose from some 900,000 to more than 3 million, and sales of male condoms also increased.

Involving men

One person who has seen the change coming is Langton Ziromba. He owns a small, outdoor barbershop in the Budirio section of Harare. In addition to haircuts, shaves and chats about football and women, Mr Ziromba provides another service to his male customers: information about female condoms, how they are used, and the advantages to both partners. He is one of about 70 barbers and 2,000 hairdressers in Zimbabwe who have been trained to promote the female condom. He sells Zimbabwe’s most popular brand, called Care, and makes a small commission on the highly subsidised price.

“Our research shows that for this product to be accepted and used by women, we also need to involve men,” says Margaret Butau of the National Family Planning Council. “We customise the benefits of the female condom according to the target group we are addressing.” Specific points highlighted for men include the fact that the female condom is not constricting like the male condom, it is even less prone to breakage, its use does not require an erection and it can enhance pleasure for both partners. Moreover, it is not necessary to withdraw immediately after ejaculation. And, finally, it could be seen as the woman’s responsibility. “When we point all this out, we find that men become curious about having their partners try the product.”

Providing a model for other countries

The Zimbabwe campaign created by PSI that uses hairdressers to market condoms has served as a model for a similar programme in Malawi. Some 2,400 Malawian hairdressers now sell, and serve as advocates for, the female condom in the country. Their numbers are growing as word spreads. Sandra Mapemba, a national programme officer in the UNFPA office in Malawi, says the impact has been dramatic. “The female condom is actually empowering women to become more assertive and to stand up for their own health issues,” she says. “That’s the most exciting thing for me. Women who are in discordant relationships or women who are HIV-positive come and tell me that now they can actually insist on condom use. Before, their partners would refuse.”

The response has been so positive that UNFPA Malawi is now providing training in condom programming to some 35 international and local NGOs working on HIV-prevention in the country. Over the course of three years, female condom distribution through the public sector alone in Malawi increased from 124,000 in 2004-2005 to nearly a million in 2008.

Programming challenges persist

The success of UNFPA and its partners in promoting the female condom in Zimbabwe, Malawi and also in Zambia has prompted other countries to seek similar assistance. Though global distribution of female condoms nearly tripled from 2004 to 2008 – to a total of 33 million in 90 countries – they still represent only 0.2 per cent of condom use worldwide. Key barriers are cost and availability. Not only are female condoms more expensive than male condoms – they cost as much as $1 per unit in some countries – they are still far less widely available. Through an initiative called comprehensive condom programming, UNFPA is helping countries address these and other issues. The programme is also a platform from which other female-initiated prevention technologies still in development, including cervical caps and microbicides, will be launched.

“Giving women the power to protect themselves could turn the tide of the AIDS epidemic,” says Bidia Deperthes, who leads the comprehensive condom programming initiative for UNFPA. “But we still have a long way to go.” The largest obstacle, in her view, is funding for programming. While the majority of donors willingly contribute essential commodities, including male and female condoms, little money is allocated to laying the groundwork needed to create awareness and demand, and to train women to use condoms correctly and consistently. “It’s all part of one comprehensive package.”

This article was adapted from an upcoming UNFPA publication “Prevention Gains Momentum: Successes in female condom programming”.

Over 150 participants from 10 WCA countries came to the workshop
Credit: UNAIDS

A strategic combination of private sector know-how and technologies with public sector expertise and funding could lead to improved health and a more efficient AIDS response in West and Central Africa. This was the message from a one day workshop held in Ghana focusing on the role of the private sector in Global Fund processes that brought together 60 companies, 10 national business coalitions tackling HIV and employers federations, as well as trade unions and development partners from all over West and Central Africa.

The workshop was organized at the initiative of UNAIDS and with the support of the Global Business Coalition on HIV/AIDS, TB and Malaria (GBC), the Global Fund to Fight AIDS, TB and Malaria (Global Fund), the International Labour Organization (ILO), the German Development Cooperation (GTZ), and Partenaires contre le Sida (PCS). The October 22 workshop followed a two day event on malaria organized by the GBC.

“If we work together to ensure that the resources, know-how, and technologies of the private sector are strategically combined with public sector funding and expertise, we can significantly improve the health and well-being of people in West and Central Africa, and around the world,” said John Tedstrom, GBC’s President and CEO. “By sharing best practices, and collaborating with the Global Fund to ensure that help is delivered to the areas of greatest need, we may finally have the ability to slow down and eventually defeat AIDS, TB and malaria.”

During the lively discussions, participants shared ideas and identified opportunities to partner with the Global Fund both as fund recipients, and as co-investors, in order to scale-up community HIV, TB and malaria programmes. Businesses also discussed how to deploy their resources, skills and expertise to support oversight and governance of the Global Fund mechanisms and processes at the local level. Technical support providers described how and where private sector actors could obtain relevant support at each of the various stages of the Global Fund processes.

The Ministry of Health in Ghana gave the keynote speech
Credit: UNAIDS

The Minister of Health of Ghana, Benjamin Kumbuor gave a keynote speech at the event. He highlighted the importance of working hand in hand with the private sector to support the implementation of HIV, TB and malaria programmes, and that Ghana serves as a good example of this. According to the Minister, the momentum seen in his country should extend across the continent and serve as catalyst for greater impact in reducing the social and economic burden of these epidemics. It also means working collectively to yield greater return on investments and more impact on the ground. UNAIDS agrees. “We need smarter investments in the AIDS response, to ensure that we can achieve more with less,” said Léopold Zekeng, UNAIDS Country Coordinator in Ghana. “As long as there are five people newly infected for every two people starting HIV treatment, we will not change the trajectory of the epidemic. The Global Fund is a strategic and responsive investor in AIDS, and UNAIDS is working in close partnership supporting the Fund’s full grant cycle – from the development of AIDS grant proposals, to programme implementation, to monitoring and evaluation.”

A group photo with all key partners involved in the organization of the workshop: from left to right, GBC CEO, Ghana AIDS Commission Director, Minister of Health, UNAIDS Ghana Coordinator and the UN Resident Coordinator in Ghana.
Credit: UNAIDS

Peer outreach workers, Infection Control Society of Pakistan, Karachi.
Credit: UNAIDS/P. Virot

In a move to counter social exclusion and change discriminatory practices, a dialogue has begun in Pakistan between the government, parliamentarians and communities often overlooked by policymakers. An historic meeting was held late last month when a number of parliamentarians began a dialogue with community members on the challenges facing transgendered people, people who use drugs and people living with HIV. This meeting was a first, and aimed to create an enabling environment for policy changes related to HIV.

Among the general population in Pakistan HIV prevalence is less than 0.1%, however results from the recent HIV Second Generation Surveillance in the country indicate that injecting drug users and the transgender community are the two populations with the highest rate of HIV infection in the country, with an estimated 20% and 7% prevalence respectively. HIV infection is not the sole concern of these populations who can also be caught up in a cycle of social and economic exclusion exposing them to marginalization and violence, limited access to health and others services, and, for drug users, a lack of drug substitution programmes.

The dialogue, held at a parliamentary sub-committee level, brought together parliamentarians from across party lines; associations and groups representing people living with HIV such as the Red Ribbon Initiative, Pak Plus and New Light AIDS Control Society; the Sathi Foundation for transgenders; as well as Nai Zindagi, an organization that provides services for drug users.

It was also an opportunity for parliamentarians to discuss with senior police, narcotics control and health officials who were present the need for changes in policy and practice towards key groups. Discussions ranged from an urgent call to push through pilot substitution therapy which is still awaiting final government clearance, to introducing a special focus on transgender within police training and investigations on sexual violence and abuse perpetuated against them.

Outreach Work among drug users. Nai Zindagi, Lahore.
Credit: UNAIDS/P. Virot

The government of Pakistan already endorses harm reduction within a wider approach to drug prevention and control, and non-governmental organizations collaborate closely with the Ministry of Health on needle exchange programmes.

Discussions also touched on issues affecting the general population. People living with HIV in Pakistan risk losing their employment or at times refusal by health workers to provide care to them; and people working overseas such as in the Gulf States have faced deportation back to Pakistan once detected HIV positive.

The Pakistan government’s response to HIV began in 1987 with the establishment of a Federal Committee on AIDS by the Ministry of Health, soon after the first case of AIDS was reported. Today the country’s National AIDS Control Programme is implemented through federal and provincial implementation units.

Funding gap

However Pakistan is currently facing a considerable gap in funding the scale-up of community-based efforts which represent the backbone of the national AIDS response. The country benefits from donor support, in particular from the World Bank, UK and other bi-laterals to scale up HIV prevention, treatment, care and support. Despite applications for resources from the Global Fund to Fight AIDS, TB and Malaria in recent years, grants on HIV have yet to be secured though needs are clear.

Needle disposal programme for people who inject drugs. Nai Zindagi, Lahore.
Credit: UNAIDS/P. Virot

Speaking during the meeting, Member of the National Assembly and Chair of the Parliamentary Sub-Committee on AIDS, Dr Donya Aziz said, “Donor support is essential for us at this point, yet, in the long run, we cannot rely on external funds. Public and private sectors must mobilise resources, while policy decisions are needed to ensure services and to address social exclusion in our communities.”

In spite of the challenges ahead, participants at last month’s gathering felt that the breakthrough in challenging mistrust towards communities heralded by this meeting is an important milestone on which progress can be built.

The dialogue is just the beginning and will be followed up with a series of meetings to be held among a larger forum of parliamentarians across party lines and civil society groups. Hopes are high that policy change and attitude change will also follow.

UNAIDS Country Coordinator for Pakistan Oussama Tawil echoes this hope, “Leadership shown by a few, through a courageous dialogue with parliamentarians represent a voice of change for countless others.”

Opening plenary of 3rd EECAAC, Moscow, 28 October 2009.
Credit: UNAIDS

The 3rd HIV/AIDS Conference in Eastern Europe and Central Asia opened in Moscow today with a ceremony attended by senior representatives of Russian Duma, Russian Ministry of Foreign Affairs, Russian Academy of Sciences and the US Ambassador to the Russian Federation.

The meeting brings together political leaders, scientists, health professionals, representatives of civil society and religious organizations as well people living with HIV. There are 2500 participants gathered from 60 countries, of whom 58% are women. The conference organizers hope it will invigorate the response to the AIDS epidemic across the region.

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.

In a plenary session, UNAIDS Executive Director Mr Michel Sidibé gave an overview of global AIDS response and outlined the way forward for achieving universal access goals. The event, which runs in Moscow until 30 October, is based on the theme “Regional cooperation. Join the Efforts for Universal Access”.

In his address, Mr Sidibé said that there has been tremendous 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. Nearly 1.5 million people are living with HIV and the majority of them live in Russia and Ukraine.

“UNAIDS is very concerned that Eastern Europe and Central Asia is the only region of the world where HIV prevalence clearly remains on the rise,” said Mr Sidibé.

“In this region, non-governmental organizations have implemented some of the best services for prevention, treatment and support in the world. In several countries of the region, harm reduction programmes are driven by civil society and we are seeing the first signs of their impact on the epidemic. I encourage the governments of this region to sustain and scale-up programmes delivered by civil society.,” continued Mr Sidibé.

Credit: EECAAC 

In the session, Mr Sidibé also highlighted some of the accomplishments that have been achieved in the region, such as the coverage of prevention of mother-to-child HIV transmission programmes that exceeds 95%, hoping that the region would be the first to eliminate HIV transmission from mother to child by 2015.

The Russian federal authorities with support from UNAIDS, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the International AIDS Society have organised the event. The organising committee is chaired by G.G. Onishchenko, Head of Russian the Federal Service for the Protection of Consumers Rights and Human Wellbeing, and the country’s Chief Sanitary Physician. The conference, first held in 2006, has traditionally been hosted in Moscow and is the leading public forum for dialogue on public health and HIV in the region.

This year’s conference aims to set priorities for the region, with special emphasis on HIV prevention among key groups, including sex workers and people who inject drugs, while taking into consideration the nature of the epidemic in each country across Eastern Europe and Central Asia.

HIV epidemic in Eastern Europe and Central Asia

According to the 2008 UNAIDS report on the global AIDS epidemic, about 1.5 million people were estimated to be living with HIV in Eastern Europe and Central Asia in 2007; almost 90% of them living in either the Russian Federation or Ukraine.

Although 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.

There is increasing political and financial commitment for HIV prevention, treatment and care in Russia, even in the face of a global financial crisis, with the country set to increase the number of people on antiretroviral treatment by 50,000 in 2009.

UNAIDS Executive Director Michel Sidibé (left) and the President of the International Olympic Committee, Jacques Rogge. Lausanne, 26 October 2009.
Copyright: IOC/Arnaud Meylan

UNAIDS Executive Director Michel Sidibé earlier today met with Jacques Rogge, the President of the International Olympic Committee (IOC) at its headquarters in Lausanne, Switzerland.

UNAIDS and IOC have a long standing partnership to enhance the role of sports organisations in the AIDS response which was formalized in the Memorandum of Understanding singed in 2004. The two organizations have also collaborated in efforts to raise AIDS awareness with coaches, athletes and sports personalities.

In 2005, an HIV prevention toolkit was developed which features practical information on HIV prevention programming and includes messages from international sports’ stars, some of whom are living with HIV. The tool kit has been translated into French, Portuguese, Chinese, Russian, Swahili and Spanish, with an Arabic version planned for 2010.

The partnership has since developed into a range of joint initiatives including the sponsoring by IOC of several regional workshops on HIV and sport, and a series of events to launch the translated versions of the toolkit.

At the meeting, Michel Sidibé thanked the IOC for the role played by IOC on HIV advocacy leveraging the National Olympic Committees as implementing arms of the IOC in responding to the HIV epidemic.

Praising the work of the IOC, Michel Sidibé stressed the importance of partnerships like this one for the HIV response. “I look forward to the growing relationship between IOC and UNAIDS. By working together in the spirit of the core values of the Olympic Movement—friendship, excellence and respect—we can be a force for positive change.”

"The partnership between our two organisations has been strong in the past and will be even stronger in the future,” said Jacques Rogge, the President of the International Olympic Committee (IOC). “The IOC and UNAIDS both try to reach out to as many young people as possible. It is our common goal to use sport as a powerful tool in the education about and the prevention of HIV & AIDS across the globe," Mr Rogge continued.

In countries with generalized epidemics, community based sports organizations and non-governmental organizations are particularly vulnerable to the impact of HIV, given that they often rely on people with specialized skills and volunteers who can be difficult to replace should they fall ill.

The partnership between UNAIDS and the IOC was particularly successful around the 2008 Olympic Games in Beijing. The “Play Safe – Help Stop HIV – Play your part in protecting the world around you” campaign for the Beijing games, was jointly planned and executed by the IOC, the Beijing Organizing Committee for the Games of the XXIX Olympiad and UNAIDS.

Highlights of the campaign include HIV awareness raising activities targeting migrant workers at construction sites of the Olympic venues supported by UNAIDS and a private partner. UNAIDS mobilized nine UN agencies, the Red Cross, Marie Stopes International as well as groups of people living with HIV, to train 7,000 Olympic volunteers on HIV prevention and countering stigma and discrimination.

The activities reached close to 100,000 young people that had volunteered for the Beijing Olympics with information about HIV and sexual health. 100,000 high quality condoms packaged in 50,000 leaflets with information on HIV prevention and anti-discrimination were made available in the clinics in the Olympic Villages.

During the meeting Mr Sidibé also congratulated the IOC on having been granted permanent observer status to the United Nations General Assembly in New York. The decision pays tribute to the IOC’s efforts to contribute to the achievement of the UN Millennium Development Goals by using sport as a tool, the IOC and its partners implement various activities across the globe

At the meeting, Mr Sidibé and Mr Rogge also discussed future joint activities at the Vancouver 2010 Winter Games, Singapore 2010 Youth Olympic Games and London 2012 Summer Games.

The forthcoming collaboration between IOC and UNAIDS around the London Games will focus on HIV prevention as well as countering stigma and discrimination around HIV. Together IOC and UNAIDS can make a difference and promote the Olympic values and instil hope.

Lasith Malinga, a star player on the Sri Lanka Champions Trophy cricket team, gives a mini-bowling clinic to a group of children in the UNICEF-supported ECHO adolescent development programme in Katlehong Township, South Africa Credit: UNICEF South Africa/2009/Ingham-Brown

Famous Sri Lankan cricketers Kumar Sangakkara, Angelo Mathews, Chamara Kapugedera and Lasith Malinga recently visited young people living with HIV at the WITSECHO Adolescent Sprint Holiday Programme near Johannesburg, South Africa.

The visit took place at the Katlehong Art Centre. It was organised in collaboration with ECHO – a local UNICEF partner that helps provide antiretroviral therapy for some 10,000 South African children – and with the THINK WISE global partnership between the International Cricket Council (ICC), UNAIDS, UNICEF and the Global Media AIDS Initiative.

The THINK WISE partnership works to educate cricket players, coaches, commentators, broadcasters, volunteers and spectators about the AIDS epidemic and HIV prevention.

Raising awareness

Following a spirited fielding session, the cricketers heard from the staff and young people at the youth programme about the work it does to help adolescents develop life skills. The programme trains peer educators to encourage HIV prevention by building the self-esteem and confidence of other young people – and thereby help them make responsible choices.

Most of the children in attendance had contracted HIV from their mothers, who either did not know that they were HIV-positive when they were pregnant or did not have access to treatment that could have prevented them from transmitting the virus to their children.

“It is fantastic to be here today to see firsthand the work that local partners carry out to tackle HIV,” Mr. Sangakkara said, speaking as an ambassador of THINK WISE and the cricketing community. “The work that this programme does has a real impact on the life of these young people and gives me great hope,” he added.

Protection, respect and fairness

Sri Lanka captain Kumar Sangakkara chats with children in Katlehong Township
Credit: UNICEF South Africa/2009/Ingham-Brown

“I hope that young people living with HIV can grow up without discrimination and can lead fruitful lives,” said Mr. Mathews. “The young people I have met today are an inspiration, and I hope more people across the world will be able to make informed decisions as they grow up.”

The goals of THINK WISE include encouraging youths to protect themselves and others, and to show respect and fairness to people living with HIV.

“Protection, respect and fairness – these are all values which cricketers easily relate to in our own sport,” said Mr. Malinga.

Catherine Sozi, UNAIDS country coordinator for South Africa, welcomed the visit. “We really appreciated the cricketers taking time to meet young people living with HIV and helping to raise awareness about key issues such as prevention and stigma and discrimination. THINK WISE is a pioneering partnership which brings anti-AIDS messages home in innovative ways and its ambassadors are doing a great job.”

South Africa bears a heavy AIDS burden with an estimated 5.7 million people living with HIV, some 280,000 of whom are children under the age of 15. There are also around 1.4 million children under 17 who have been orphaned due to AIDS.

Executive Director of UNAIDS Mr Michel Sidibé participated in a panel on global health challenges, 22 October 2009, Stockholm.
Credit: UNAIDS

The European Development Days opened yesterday in Stockholm by Her Royal Highness Crown Princess of Sweden Victoria, the President of the EU Commission José Manuel Barroso and the Swedish Prime Minister Fredrik Reinfeldt.

The three day event brings together more than 1500 organizations and 400 individuals from the development community to discuss how to make development aid more effective, and it aspires to build a global coalition to achieve the Millennium Development Goals (MDGs) for 2015.

The European Development Days are hosted jointly every year by the European Commission and the EU presidency, with this year’s event being the fourth edition.

The Executive Director of UNAIDS Mr Michel Sidibé participated in a panel on global health challenges, which explored ways of making the world a healthier place, despite the ailing state of the global economy.

Mr Sidibé emphasized that the world is lagging behind when it comes to HIV prevention, outlining key barriers to halting the spread of HIV including investing resources with populations who are criminalized and marginalized.

“We have effective prevention interventions – however we are not convincing enough decision-makers to invest sufficiently in them”, Sidibé continued, stressing that success will require building an HIV prevention movement with the grassroots to over come political inertia.

He also expressed the need for programmes to “address sexuality and gender inequality in frank, open ways, keeping up with a changing epidemic.”

Executive Director of UNAIDS Mr Michel Sidibé meet with the former President of Mali, Mr Alpha Oumar Konaré during the European Development Days, 22 October 2009, Stockholm.
Credit: UNAIDS

The session also focused how to meet the health related MDGs, and Mr Sidibé spoke of the need to take the AIDS response out of isolation saying that policy-makers should leverage the energy and creativity of the AIDS movement to deliver on the AIDS+MDG agenda.

Lluis Riera, Director for Development Policy at the European Commission's Directorate General for Development, Michel Kazatchkine Executive Director of the global fund to Fight AIDS, TB and Malaria and Anders Nordström, Director General of the Swedish International Development Cooperation Agency (Sida) also addressed the session.

The Global Health Challenges session was a joint initiative of UNAIDS, The Global Fund to Fight AIDS, TB and Malaria, the GAVI Alliance, the Stop AIDS Alliance, and AIDS Accountability International.

Executive Director of UNAIDS Mr Michel Sidibé with Mr. George Soros during the European Development Days, 22 October 2009, Stockholm.
Credit: UNAIDS

While in Sweden, Mr Sidibé also took the opportunity to meet with Swedish non-governmental organizations (NGO) engaged in the AIDS response. Among them Noah's Ark, an NGO that has been involved in the fight against HIV since 1986, as well as representatives of the Swedish Network of People Living with HIV.

The European Development Days is hosted by the current EU President, Sweden and will conclude on 24 October.

Nigeria’s Minister of State for Information and Communication, Mr Alhaji Aliyu Ikra Bilbis, launched the campaign.
Credit: UNAIDS

To mark World Post Day on 9 October, Nigeria held a national launch of a global awareness campaign in collaboration with the Universal Postal Union, UNAIDS, the ILO and UNI Global.

Nigeria’s Minister of State for Information and Communication, Mr Alhaji Aliyu Ikra Bilbis, launched the campaign by calling for the involvement of more stakeholders to support the government in the AIDS response in a comprehensive manner, adding, “Nigeria has demonstrated dynamism in the response to HIV.”

While congratulating Nigeria Post (Nipost) on its latest effort towards contributing to achieving the Millennium Development Goal of halting and reversing the spread of HIV by 2015, UNAIDS Country Coordinator Dr Warren Naamara said, “Nigeria has shown her commitment to achieving this MDG goal, but there is still a need to get more stakeholders and players on board so that the country’s response to HIV reaches even more people.”

Dr Naamara encouraged Nipost to collaborate with the country’s National Agency for the Control of AIDS and the State Agencies for the Control of HIV to build a sustainable comprehensive multi-sectoral response to HIV and AIDS.

This innovative campaign provides post office visitors and employees with important information about how to prevent HIV through a series of eye-catching posters and hand-outs. The materials also give the address of a multi-language website on HIV prevention, hosted by UNAIDS, which provides detailed information about how to prevent infection.

The campaign in Nigeria is part of the first phase in a series of similar drives undertaken by the participating agencies in six other countries: Brazil, Burkina Faso, Cameroon, China, Estonia and Mali. The countries were chosen because of their HIV prevalence rates and to give a broad geographical spread. Nigeria has an HIV prevalence of 3.1% and ranks second only to South Africa in terms of the number of people living with HIV.

UNAIDS Executive Director Mr Michel Sidibé has commended the campaign for its innovativeness, saying, “The postal network has an extremely wide outreach; it is open to everyone from the young to the old and is an excellent and innovative way to raise awareness about how to prevent HIV.”

The Postmaster General of Nigeria Mallam Ibrahim Mori Baba read a statement at the launch.
Credit: UNAIDS

During the first phase, nearly 24,000 post offices in seven countries are displaying and distributing information materials with more UPU member countries expected to join later. For the second phase, ILO is preparing a toolkit for postal employers to inform their staff about HIV. UNI Global, a global union which brings together over 900 trade unions representing over 15 million members worldwide, is working closely with the postal departments and trade unions for this phase. The third phase is planned for 2011, where the UPU will invite its member countries to issue a stamp to commemorate the identification of AIDS in 1981.

In many parts of the world, post offices already have a social role by promoting public health messages within their community. Over the next three years, the campaign will be expanded globally, potentially making its way into 600,000 post offices worldwide. This would mean that millions of people who use postal services every day as well as the 5.5 million postal employees worldwide would receive important information about how to prevent HIV transmission.

UNAIDS Executive Director Michel Sidibé at the press conference of the 2009 AIDS Vaccine Conference. Paris, 19 October 2009. Credit: UNAIDS

The yearly AIDS Vaccine Conference opened in Paris today. High on the agenda are discussions on the progress made in vaccine development and implications of trial results for the future. In a keynote address to the conference, UNAIDS Executive Director Mr Michel Sidibé said access and affordability were the first challenges towards building an effective AIDS response.

Mr Sidibé spoke about positive developments related to the AIDS vaccine research field. The recent results in Thailand have given hope to the many scientists who are working on finding a safe and highly effective HIV vaccine. These efforts demonstrate the vigour and momentum of the collective global effort to deliver on the promise of AIDS vaccines, said Mr Sidibé.

The UNAIDS Head also spoke of the challenge in creating conducive conditions for massive uptake of an effective AIDS vaccine. Antiretroviral treatment has been around since 1996, but real access to treatment only came about after public pressure put on world leaders – as a result the prices of medicines came down giving millions of people living with HIV in developing countries access to treatment.

Today, AIDS activists are repeating these efforts to reduce prices, this time for second line antiretroviral medicines.

“A ready to use vaccine against HIV could be more than a decade away, but when it does become available, it needs to be financed as a public good that is accessible for all,” Mr Sidibé said, “Meanwhile we have to redouble our combination HIV prevention efforts to stop the continuing tide of new HIV infections.”

AIDS Vaccine 2009 will bring together established and young research scientists, with clinicians, epidemiologists and public health experts aimed at sharing experience and scientific advances and enhancing collaborations.

The first AIDS Vaccine Conference, organized by the Global HIV Vaccine Enterprise, was held in Paris in the year 2000 with the aim of advancing the field of HIV vaccine research through discussion, exchange and learning. The annual meeting is now seen as the leading forum for exchange of scientific information relating to the difficult challenge of developing an effective vaccine against HIV. It will conclude on 22 October.

Vocational schools in China provide an avenue for reaching thousands of young people with HIV/STI prevention messages. Credit: ILO

The Zhaoqing Vocational School in Guangdong, China, provides basic technical skills to several thousand migrant workers a year. It is also one of the first schools of its kind in the country to include information on sexuality, reproductive health and HIV in its core curriculum. This model has now been scaled up nationally with technical assistance from the International Labour Organization (ILO).

Many graduates from Zhaoqing’s school will find jobs along the province’s Pearl River Delta, which is the largest manufacturing zone in the world and employs over 60 million migrant workers from China’s rural areas. Before the students, who range in age from 14 to 19, enter the world of work, teachers are committed to imparting knowledge which will help protect them against frequent incidences of unwanted pregnancies and reportedly high rates of sexually transmitted infections such as HIV.

For many young people at the school the intervention seems to be working and they are reaping the benefits of greater openness and access to information. According to one female student, “At the beginning of HIV training I felt very nervous and shy. After the teacher's explanation I felt natural and accepted what she said. I felt I had known nothing about HIV… People with HIV are not dangerous and they don't deserve any discrimination.”

Vocational schools in China provide an avenue for reaching thousands of young people with HIV/STI prevention messages. Credit: ILO

Using the example of Zhaoqing and other similar schools, the ILO and the United States Department of Labor, (USDOL) have set out to reach as many of the 18 million students in the country’s 16,000 vocational schools as possible.

The ILO/USDOL project, known as SHARE (Strategic HIV/AIDS Responses in Enterprises), recognises that vocational schools are in a position to reach large
numbers of vulnerable young people with HIV, STI and reproductive health
training.  A survey of 1,602 female students from vocational schools in Anhui, for example, showed that nearly 12% said they had had sex and, among these, more than 60% reported pre-marriage pregnancies.

Based on this need, SHARE has established programmes in 1000 vocational schools and trained over 2000 teachers in delivering participatory training. The Chinese Ministry of Human Resources is supporting this effort with a national policy which requires all vocational schools under its authority to integrate STI, HIV and reproductive health training into the psychological health curriculum.

According to Richard Howard, ILO Chief Technical Advisor of the HIV/AIDS workplace education project in China, "It is estimated that with the capacity built
in the vocational schools, five million students will be reached in China over the next five years.”

The authorities in the country are very much aware that, despite early successes, the project needs careful monitoring and evaluation. “Challenges ahead include how to track the impact of this intervention,” says Zheng Dongliang, from the Ministry of Human Resources and Social Security and National Project Director of the ILO/USDOL HIV/AIDS workplace project. He adds, "We can now assess how that knowledge has been transferred during examinations but our objective is to facilitate behaviour change and we are looking at ways to better monitor and evaluate the impact of the interventions to make sure we achieve positive behaviours among these vulnerable youth.”

In principle, sex education in Chinese schools was established in 1992. However, its implementation and effectiveness varies. Ms. Li Hua, a teacher at the Wuhu vocational school reports that “most often it is the teachers who are embarrassed to talk about sex with their students. The students are eager to learn and – when given the right space – talk openly about their experiences”. It is one of the objectives of this programme to equip teachers with the knowledge, the skills and tools to frankly discuss sexual and reproductive health issues in class.

“It is refreshing and encouraging to see teachers and students interact in a lively and imaginative way about rather private matters”, says Dr Bernhard Schwartländer, UNAIDS Country Coordinator in China. “Programmes like the one supported by ILO can serve as an excellent model to reach tens of millions of young people and their partners in China, right at the age when they are most prone to behaviours that put them at risk of HIV or other sexually transmitted infections.”.