To promote a bigger role of NGOs in the HIV response in Moldova, the League of People Living with HIV of Moldova in collaboration with UNAIDS, hosted a two-day national NGO forum in Chisinau. Credit: UNAIDS

Speaking with many voices and representing many different perspectives, the non-governmental organizations (NGOs) play a key role in the response to the AIDS epidemic in countries around the world. As key partners in the development of national AIDS responses, NGOs are well positioned to provide quantative and qualitative information to augment the data collected by governments.

To promote a bigger role of NGOs in the HIV response in Moldova, the League of People Living with HIV of Moldova in collaboration with UNAIDS, hosted a two-day national NGO forum in Chisinau in the middle of June.

Bringing together more than 120 representatives from the civil society, government and international organizations, the Third Forum of Nongovernmental Organizations of Moldova active in area of HIV and TB included 26 NGOs representing all regions of Moldova. Presenting results achieved in the past year while exchanging opinions and experiences, participants agreed that joint efforts are essential for an effective response to AIDS.

Oleg Lozan, Vice Minister of Health, said at the opening ceremony that Moldova has made progress in the AIDS response thanks to the joint efforts made by government and non-governmental organizations. “The civil society’s contribution is huge,” said Lozan, “NGOs have largely covered areas insufficiently reached by the state in the AIDS response.”

Civil society participation in responding to the epidemic has been institutionalized in Moldova through the establishment of several coordination mechanisms such as the Harm Reduction Network, the network of NGOs working in the field of HIV, and the National League of People Living with HIV.

Presenting results achieved in the past year while exchanging opinions and experiences, participants agreed that joint efforts are essential for an effective response to AIDS. Credit: UNAIDS

The government of Moldova supports the involvement of NGOs in scaling up the country’s response to HIV. NGOs are active members of the National Coordination Council TB/AIDS and its associated technical working groups and they have fully participated in the formulation of the new 2007 Law on Prevention of HIV/AIDS.

“Civil society involvement has been consolidated in the country and they have contributed to the progress made in different priority areas of the national AIDS response such as HIV prevention, adherence to ARV treatment, harm reduction, and support and care for people infected with and affected by HIV,” said Gabriela Ionascu, UNAIDS Country Coordinator.

HIV in Moldova

Moldova is classified as a country with low prevalence of HIV. According to UNAIDS 2008 Report on the Global AIDS Epidemic, an estimated 8,900 people are living with HIV in the Republic of Moldova, with 29% being women.

The main mode of transmission is the use of contaminated equipment by injecting drug users. However there are signs of HIV spreading into the general population as unprotected sex is an increasing mode of transmission in the country.

According to a national report issued by National Centre on Health Management in 2008, the proportion of Moldova women among newly reported HIV cases with sexual route of transmission is also growing (62% in 2007, compared to 57% in 2006).

Dr Jorge Sampaio, the UN Secretary General’s Special Envoy to Stop TB and UNAIDS Executive Director Michel Sidibé together witnessed, first-hand, delivery of integrated HIV and TB services during a visit to the Socio-Medical Centre in Biryogo.

"It is gratifying to be at this clinic, which has intensified TB case finding in people living with HIV through TB screening and transferring confirmed cases to a TB clinic. In addition patients who enrol at the health centre with tuberculosis are also tested for HIV and those found to be HIV positive are given integrated care and support. It is a programme that reflects Rwanda's impressive progress nationwide on coordinating TB and HIV services," said Dr Jorge Sampaio, the UN Secretary-General's Special Envoy to Stop TB.

Mr Sidibé highlighted the progress Rwanda has made in improving the outcome of TB and HIV co-infection through better collaboration and the use of innovative diagnostic technology and underlined the UN’s commitment to effectively tackling the dual epidemics.

“I am pleased to see that Rwanda is leading Africa and the world in taking an integrated approach to dealing with the interlinked epidemics of TB and HIV. Rwanda’s bold leadership is achieving impressive results that show the rest of Africa what can be achieved," said Mr Sidibé said.

Mr Sidibé emphasize that tackling TB and HIV jointly is a priority for UNAIDS and, as stated in the UNAIDS Outcome Framework 2009-2011, it is one of the nine key areas for achieving results with the final goal being that no person living with HIV should die of TB.

Dr Sampaio and Mr Sidibé proceeded to another joint visit to Rwanda's National Reference Laboratory in Kigali, where they saw evidence of the country's major investment in laboratory services.

Rwanda has been tackling a thorny issue -- the difficulty of diagnosing TB among people living with HIV. TB diagnosis requires visualization under a microscope of the bacteria that cause the disease, obtained via sputum samples. Among people living with HIV, often few bacteria are present in the sputum and they are therefore not detectable through conventional diagnosis, even if the person has serious TB disease. Consequently the diagnosis is often missed.

The sensitivity of a TB diagnosis can be improved by incubating the samples to multiply the TB bacteria; but this process can take weeks or even months using conventional methods. To increase speed and accuracy of TB diagnosis, fast liquid culture (MGIT) will be introduced and rolled out soon in Rwanda. The National Reference Laboratory is also studying more efficient microscopes and staining techniques to improve speed of TB diagnosis.

Since 2004 Rwanda has had the capacity to test for drug-resistant TB. The National Reference Laboratory and the other main laboratories in the country are also currently developing their capacity to diagnose cases of XDR-TB (although none have been detected in Rwanda to date).

Dr Sampaio and Mr Sidibé congratulated the laboratory staff on their excellent work and recognized the key role they play in reducing deaths from TB among people living with HIV.

They highlighted the need for much greater investment in strengthening laboratory services and committed to advocating for increased investment in research for a faster, simpler and more accurate TB test.

President of Rwanda, H.E. Paul Kagame (right) met with UNAIDS Executive Director, Michel Sidibé. Rwanda, 1 September 2009. Credit: UNAIDS/L.Rusanganwa

UNAIDS Executive Director Michel Sidibé has met with President of Rwanda, H.E. Paul Kagame, and the First Lady of Rwanda, H.E. Jeanette Kagame, as well as representatives of civil society organizations.

Yesterday he addressed the 59th session of the World Health Organization’s (WHO) Regional Committee for Africa in Kigali. Mr Sidibé stressed the urgent need stop new HIV infections and called for a sea-change approach to prevent sexual transmission of HIV. “Prevention must become our watchword, the banner we raise in this critical stage of the response,” said Mr Sidibé.

Mr Sidibé also congratulated Dr Luís Sambo on his re-election as the WHO Regional Director for Africa and reiterated the full support of UNAIDS to him and WHO. The two organizations collaborate closely on several fronts including the Harmonization for Health in Africa initiative. Mr Sidibé spoke about the importance of the goal of primary health care: “These and other such efforts will enable us to do more with less—and do it more sustainably,” he said.

First Lady of Rwanda, H.E. Jeanette Kagame with UNAIDS Executive Director, Michel Sidibé. Rwanda, 28 August 2009. Credit: UNAIDS/L.Rusanganwa

UNAIDS Executive Director Michel Sidibé is paying his first official visit to Rwanda from 27 August to 3 September to recognize and support the achievements of the Government of Rwanda in the HIV response and conduct high-level advocacy for universal access to HIV services and the Millennium Development Goals.

Mr Sidibé will meet with the President of Rwanda, H.E. Paul Kagame, and the First Lady of Rwanda, H.E. Jeanette Kagame, to discuss the current global and regional opportunities and challenges in tackling HIV and how they will influence the long-term AIDS response in Rwanda and across Africa. Meetings are also scheduled with representatives from the private sector, civil society, including people living with HIV, and high-level representatives from the government and UN agencies. The meetings will provide an opportunity to address the United Nations’ support in Rwanda’s HIV response.

Mr Sidibé will visit several projects, including Rwamagana Hospital which offers prevention of mother-to-child HIV transmission (PMTCT) services and integrated health services. It is estimated that around 56% of HIV-positive pregnant women received antiretroviral therapy (ART) in Rwanda. By the end of the year, it is expected that the coverage will reach 70%. The target coverage for 2012 is 90%.

A visit is also planned to Biryogo’s health center where the UNAIDS Executive Director will witness first-hand the delivery of integrated HIV and TB services as well as nutritional support in health settings. He will also stopover at an association of former sex workers in Muhanga District, considered a model of community best practices in HIV prevention and AIDS impact mitigation.

UNAIDS Executive Director will provide the opening remarks at the fifty-ninth session of the WHO Regional Committee for Africa. Mr Sidibé will emphasize the need to transform Africa’s pharmaceutical sector by creating an African Medicines Agency in order to face emerging health threats as well as putting Africans in control of their development.

Progress towards Universal Access

With an HIV prevalence estimated to at around 2.8%, there are an estimated 150.000 people living with HIV in Rwanda, including around 19,000 children according to the 2008 UNAIDS Report on the global AIDS epidemic. Despite these figures, Rwanda appears to be on track to meet its current universal access targets.

Review of national reports in 2008 demonstrated that universal access has catalyzed an accelerated and strengthened national HIV response with more results-based planning and a general overall increase in access to HIV services. National political leadership and coordination were found to be critical in the scale up.

However more emphasis was needed on accelerating progress on HIV prevention efforts, and to better utilise the resources available within civil society and people living with HIV.

The increase of antiretroviral therapy (free and integrated into health services) is a major success for the country. ARV coverage was 63% at the end of 2008 and the target coverage for 2012 is expected to reach 91% of the people in need. Furthermore, there has been a significant increase in percentage of facilities offering ARV services from 7% in 2004 to 45% in 2008.

Rwanda has adopted an expanded the ABC (abstinence, be faithful, use a condom) approach to include education; so that it is known as EABC and numerous partners are involved in awareness work (about 500 000 people were reached by prevention messages in 2006). However, little data are available to convey a clear sense of the scope of HIV prevention programmes with regard to most-at-risk populations.

Therefore, an evidence-based prevention strategy has yet to be developed and fully implemented with focus on developing appropriate tailored interventions for the most-at-risk populations (prisoners, sex workers and men who have sex with men).

Joint UN Plan on HIV

In January 2007, Rwanda became one of the eight pilot countries for the One UN Reform initiative. UN agencies in Rwanda are now working towards ‘One Programme’, ‘One Leader’, ‘One Office’ and ‘One Budgetary Framework’. In order to ensure that its contributions support and reinforce the priorities of the national response to HIV in Rwanda, the UN system has developed a Joint UN Plan on HIV for the period 2008-2012.

The Joint Plan comprises three main focus areas for HIV: the “Three Ones” principles (lead agencies UNDP/UNAIDS); increased awareness and intensified prevention (lead agencies UNICEF/UNFPA); and scaling-up treatment, care and support (lead agency WHO). To ensure accountability, each of the lead agencies is responsible for their own achievements.

A version of this story was first published at UNICEF.org

UNICEF UK Ambassador and Manchester United player Ryan Giggs enjoys a lively conversation with a refugee teen whose parents come from Myanmar and who spends his free time as a football coach for younger refugee children in Malaysia.
Credit: UNICEF Malaysia

Manchester United stars Ryan Giggs, Patrice Evra and Federico Macheda, along with Manchester United Foundation Chief Executive John Shiels, took time out of the club's pre-season tour of Asia in mid-July to help UNICEF champion the rights of vulnerable children and those affected by HIV in Malaysia.

The football stars visited Positive Living, a programme operated by the community-based PT Foundation. The group spent time with 10 young people from various challenging backgrounds – including children from families affected by HIV, and children whose parents are sex workers or drug users, as well as street children and young refugees.

Despite Malaysia’s progress in child health and education, many children still find themselves living on the margins of society as a result of discrimination, stigma and prejudice. These marginalized children are in the highest-risk category for HIV infection.

Stark realities for children

Joined by the players for an intimate discussion, the young people at Positive Living shared their feelings, dreams and daily experiences, revealing the stark realities of life for youths shadowed by HIV, drug abuse, violence, exploitation and displacement.

Mr. Giggs spoke with Asha (not her real name), 15, whose father died as a result of AIDS-related illness. Asha recalled the day her mother revealed her own HIV status.

“When my mother told me that she was HIV-positive, I panicked and didn’t know what to do,” she said. “I could not accept it.”

After her father died, Asha and her mother were forced to move from their home and community due to AIDS stigma and discrimination. “After my father passed away everyone hated my mother. Everyone hurt her,” she said.

Fair and equal treatment

Credit: UNICEF Malaysia

Through their visit, the Manchester United players aim to highlight the facts about HIV, help break down the prejudice and stigma faced by marginalized children; and advocate for their right to be treated fairly.

“It’s tragic to hear how marginalized children and those affected by HIV suffer as result of stigma,” said Mr. Giggs. “But by joining these children here today and showing our support, we hope to send out a powerful message – that all children, no matter their background, where they live or their HIV status, should be treated equally.”

UNICEF is working with the government and partners to challenge discrimination, protect children, reduce stigma and promote awareness of these issues – including HIV prevention in a country where an estimated 80,000 people are living with the virus.

Challenging stigma is vital

“Fighting against stigma is a vital step in protecting marginalized children,” said Mr. Evra. “To do this, we must all learn the facts about HIV: You cannot get HIV by playing with children who are HIV-positive.”

Manchester United player Federico Macheda participates in a sharing session with vulnerable children in Malaysia.
Credit: UNICEF Malaysia

The footballers’ visit represents the latest development in the ground-breaking 10-year ‘United for UNICEF’ partnership between Manchester United and UNICEF and highlights the club’s continuing commitment to UNICEF’s 'Unite for Children, Unite against AIDS' global campaign. UNICEF is a cosponsor of UNAIDS.

Since 1999, the partnership has raised over $3.75 million, benefiting over 1.5 million children worldwide. In 2007, the club donated more than $150,000 to UNICEF Malaysia for youth HIV-prevention programmes.

“Lasting solutions for the next generation must address both protection from HIV and protection of children's rights," said UNICEF Representative to Malaysia Youssouf Oomar. "These rights are not merely the benefit of a few but the entitlement of all children, regardless of their identity, HIV status, geographical location or gender."

The ‘United for UNICEF’ 10th anniversary coincides with the 20th anniversary of the Convention on the Rights of the Child this year.

Participants at the regional consultation organized by the UNAIDS Regional Support Team, in collaboration with three regional civil society networks (AfriCASO, International HIV/AIDS Alliance, ENDA Santé) in Dakar from 11 to 14 August 2009. Credit: UNAIDS

Thirty civil society organizations involved in the HIV response in West and Central Africa (WCA) identified six priority areas for action to accelerate the movement towards universal access to HIV prevention, treatment, care and support in the region. This decision was the outcome of a regional consultation organized by the UNAIDS Regional Support Team, in collaboration with three regional civil society networks (AfriCASO, International HIV/AIDS Alliance, ENDA Santé) in Dakar from 11 to 14 August 2009.

The consultation was an opportunity to define concrete actions to be taken in the West and Central African region to achieve universal access targets and Millennium Development Goals considering the central role played by civil society organizations in the response to AIDS.

Over four days, the consultation brought together representatives of regional and national networks of people living with HIV, women, youth, religious leaders, parliamentarians, media, traditional practitioners, human rights associations, people with disabilities, trade unions, men who have sex with men, international NGOs involved in the HIV response as well UN system representatives.

Despite significant efforts in recent years made by countries to improve the response to the epidemic, participants underscored that many challenges remain to be addressed by all stakeholders to accelerate the movement towards universal access in West and Central Africa. Participants committed to coordinate their efforts towards the following six priority areas: Sustainable funding of the AIDS response; integration of HIV, tuberculosis and sexual and reproductive health services; improving the legal and societal framework; access to treatment and accelerating prevention; access to prevention of mother-to-child HIV transmission services; and innovation, communication and partnership.

For example, only 11% of pregnant women requiring services to prevent mother-to-child HIV transmission have access to them and only 25% of people living with HIV in need of antiretroviral drugs have access to treatment. The participants underlined that the quality and coverage of services and interventions targeting most-at-risk populations need to improve in most of the region. They noted the urgency to support countries in adopting laws protecting human rights that guarantee access to HIV services for all and provide effective protection for the most-at-risk populations. Participants also highlighted the urgent need to integrate HIV services into the tuberculosis programmes.

UNAIDS and its cosponsor UNFPA have been ranked as best performers in a recent assessment of four UN agencies, including UNDP and WHO, conducted by UK’s Department for International Development (DFID). As a result, both organizations will receive full additional funding to further support projects on the ground.

Announcing the results of the assessment, International Development Secretary Douglas Alexander underlined his firm commitment to rewarding results and reforms that make the UN more efficient and effective. The four agencies were assessed against a range of challenging targets and awarded an overall score which determined levels of additional funding.

UNAIDS has been allocated a 100% additional payment of £1.03 million. This is on top of the £10 million core funding the organization receives from the UK.

Joint action for results

The HIV organizational landscape has evolved and grown more complex over the past decade. UNAIDS, donors and civil society, including networks of people living with HIV, have rightly demanded greater clarity on the relationships between needs, financing, activities and outcomes.

In April 2009, UNAIDS and its cosponsors published the UNAIDS Outcome Framework 2009-2011 which, built upon the UNAIDS Strategic Framework (2007–2011), will guide future investment and hold the Secretariat and the Cosponsors accountable for making the resources of the UN work for results in countries. The framework affirms the UNAIDS Secretariat and Cosponsors to leverage their respective organizational mandates and resources to work collectively to deliver results.

Under the Outcome Framework for the period 2009–2011, UNAIDS will focus its efforts on achieving results in nine priority areas:

1. Reduce sexual transmission of HIV
2. Prevent mothers from dying and babies from becoming infected with HIV
3. Ensure that people living with HIV receive treatment
4. Prevent people living with HIV from dying of tuberculosis
5. Protect drug users from becoming infected with HIV
6. Remove punitive laws, policies, practices, stigma and discrimination that block effective responses to AIDS
7. Stop violence against women and girls
8. Empower young people to protect themselves from HIV
9. Enhance social protection for people affected by HIV

The realization of these priority areas will accelerate the achievement of universal access to HIV prevention, treatment, care and support as well as contributing to the attainment of the Millennium Development Goals.

Six Asian countries experiencing rapid economic transition have yet to prioritize HIV prevention resources for high-impact programmes. Political will and social acceptance will be needed to allocate resources for HIV services for sex workers and their clients, injecting drug users and men who have sex with men.

These are the key findings of a study focusing on China, India, Indonesia, Malaysia, Thailand, and Vietnam, carried out under the auspices of the aids2031 initiative.

The study, Asian Economies in Rapid Transition: HIV Now and Through 2031, was launched at the 9th International Congress on AIDS in Asia-Pacific. The report underlines the demographic, economic and social transformation taking place in the six countries and makes an attempt to analyze and project how these rapid changes may impact the spread of HIV in years to come. It also recommends some critical and sustainable long-term measures that will need to be adopted in order to curb the epidemic and its impact in these six countries.

The six countries studied are expected to increase their gross domestic product (GDP) per capita by between 3 and 10 percent per annum over the next 25 years, leading to higher public revenues and health spending. By 2031, each of these countries will need less than a quarter of a percentage point of GDP to pay for universal access to HIV prevention, care, and treatment. Funding for AIDS programmes will need less than one percent of the public health budget, except for Indonesia.

New trends in these six countries are changing the future scenario of the HIV epidemic. The boom in information and communication technologies, heavy migration and population mobility, rising spending power, and the growing use of recreational drugs may lead to an increase in sexual risk behaviors. The impact of these emerging trends on young people, a growing segment of the population in these six countries, is a particular concern.

Policy support and financial resources for interventions targeting most-at-risk populations must go hand in hand to implement innovative outreach programmes, according to the report. At the same time, a human rights perspective is needed to contain the social prejudice and stigma that may prevent these services to reach the most vulnerable groups.

‘If the AIDS epidemic is to be curbed,” says Prof. Myung-Hwan Cho, the Co-chair of the Working Group, “the governments in these countries will need to commit their growing resources and summon the political will to adapt policies and develop sound programmatic approaches that address inequalities, stigma and discriminatory practices”.

Asian Economies in Rapid Transition: HIV Now and Through 2031 is the first report to be launched by aids2031, an international think tank which generates new thinking on what must be done now to better manage AIDS epidemic by the year 2031.

Credit: WHO

Tuberculosis is one of the commonest causes of illness and death among people living with HIV globally. One of the major problems is that TB is particularly difficult to diagnose in people living with HIV. We have to rely on an outdated, inaccurate test that is over one hundred years old and is especially insensitive in people living with HIV.

A new web site, Evidence-Based Tuberculosis Diagnosis, has been launched that aims to provide the most comprehensive single source of evidence synthesis, policies, guidelines and research agendas on TB diagnosis. It is also a source for complete up-to-date information on the current TB diagnostics pipeline. Standard operating procedures and package inserts for several tests also are available.

‘This is an essential resource for HIV implementers, activists and civil society alike that will keep them updated on the latest developments in TB diagnosis’, says Alasdair Reid, HIV/TB Adviser at UNAIDS. ‘Without a faster, simpler, more accurate TB test we will really struggle to stop people living with HIV from dying of TB’.

The website has been established by the Stop TB Partnership's New Diagnostics Working Group in collaboration with the Foundation for Innovative New Diagnostics, the Special Programme for Research and Training in Tropical Diseases, the Global Laboratory Initiative and the Public Health Agency of Canada.

UNAIDS Goodwill Ambassador Salman Ahmad performing at the IX International Congress on AIDS in Asia and the Pacific (ICAAP), held in Bali, Indonesia from 9-13 August. Credit: UNAIDS/Donang Wahyu

Participants in a discussion on young people’s role in AIDS response at the 9th International Congress on AIDS in Asia and the Pacific (ICAAP) reached a clear and unanimous agreement: young people are essential to halting the spread of HIV.

“Young people need to be on board to turn the tide, as it is their decision-making over their bodies and their sexuality that will determine their future status,” said UNAIDS Goodwill Ambassador Salman Ahmad, a well-known rock star in South Asia, opening the first dialogue with young people at ICAAP’s Community Dialogue Space.

Co-chairing the event was James Chau, China Central Television (CCTV) talk show anchor from Beijing, who is also China’s UNAIDS National Goodwill Ambassador. “It is important that young people are empowered to participate and are given a seat in relevant forums and platforms to have their voice heard and be listened to.”

Under the theme “youth perspective on leaders' commitment about youth issues and involvement in the response”, the dialogue aimed at providing an opportunity for young people to discuss their roles in the AIDS response in Asia and the Pacific region.

Committed to advocating the involvement of youth in the AIDS response, UNAIDS Goodwill Ambassador Salman Ahmad emphasized that this kind of dialogue allows young people to prove their commitment and help shape policies and views that incorporate and represent young people. “This, in turn, can be aided by networks and networking,” said Salman. “Connecting young people, sharing knowledge and experience, building strong and sustained relationships will assist individuals to stand up and be engaged, and show leaders and decision makers that young people can and will make a difference,” he added.

Officially opened on 10 August 2009, the Asia Pacific Village provided a place where delegates can celebrate diversity as well as carry out small group discussions, informal education activities, art and dance performances, and cultural shows.

Besides directly talking and sharing views with local young people, Salman also participated in the AIDS Ambassadors meeting held on August 9. Sharing his own experience regarding youth as a resource on HIV prevention, Salman emphasized young people’s role in campaigning and advocating for the attainment of the Millennium Development Goals. “The leading question is how to harness and engage the energy and idealism of young people.”

Hosted by Ani Bambang Yudhoyono, Indonesia’s First Lady and National AIDS Ambassador, the AIDS Ambassadors and Champions Meeting aimed at addressing the need for leadership in the Asia and Pacific Region and the ways in which Ambassadors and Champions can have a greater effect in reducing the spread and impact of HIV. Promoting an agenda for youth was one of the objectives of this meeting.

As the lead singer and founding member of one South Asia's biggest rock bands "Junoon", Salman Admad became a UNAIDS Goodwill Ambassador in 2005 and has been assisting UNAIDS in its efforts to reverse the spread of HIV by raising awareness on AIDS issues.