Michel Sidibé chats with Ms Pitso of mothers2mothers
Credit: UNAIDS/G. Williams

“Strengthened services for maternal health, for reproductive health and for paediatric health will mean we can prevent mothers from dying and babies from becoming infected with HIV in Lesotho and around the world,” said Mr Michel Sidibé, UNAIDS Executive Director.

Mr Sidibé was speaking during his official visit to Lesotho which ended with a visit to the children’s ward and mother and child health section of the Queen Elizabeth II hospital in Maseru. He was accompanied by the Minister of Health Dr Mphu Ramatlapeng.

Mr Sidibé earlier was welcomed into the home of Ms Pitso a HIV-positive mother who thanks to access to services for the prevention of mother-to-child transmission gave birth 11 months ago to her baby boy Emlyn who is free of HIV. Mr Sidibé listened to Ms Pitso’s hopes for a bright future for her son. Mr Sidibé has championed the prevention of babies from becoming infected with HIV as a priority for UNAIDS and its Cosponsors.

Lesotho Minister of Health and Social Welfare Dr Mphu Ramatlapeng (left) meets Michel Sidibé, executive director of UNAIDS.
Credit: UNAIDS/G. Williams

Lesotho has made progress in coverage of prevention of mother-to-child transmission services for pregnant women, up from 5% in 2006 to 42% in the first quarter 2009. Without any intervention, an HIV positive pregnant woman’s chances of passing HIV to her baby are 30-40%. Infection transmission is the highest during pregnancy and delivery, but also during breastfeeding, especially if breast milk is mixed with other feeding. With the provision of a comprehensive prevention services, the transmission rate can be reduced to less than 2%.

“Lesotho is a model in its achievements, particularly in the field of preventing mother to child transmission of HIV,” said Mr Sidibé.

At the Queen Elizabeth II hospital, Mr Sidibé also acknowledged the contribution and commitment of health care workers. Addressing staff shortages in health and social sectors has been an aim of the Government of Lesotho who in partnership with the UN have developed an emergency human resources strategic plan, which includes ways of attracting, training and retaining health personnel.

His Majesty, King Letsie III (right) and UNAIDS Executive Director Michel Sidibé. Maseru, Lesotho. 15 July 2009
Credit: UNAIDS/G. Williams

His Majesty, King Letsie III hosted a meeting yesterday with the Executive Director. Mr Sidibé also met with and Prime Minister Pakalitha Bethuel Mosisili-Qhobosheaneng, members of Lesotho’s national AIDS Commission, and other senior government officials.

Michel Sidibé, executive director of UNAIDS (right) listens to members of civil society describe their challenges.
Credit: UNAIDS/G. Williams

During his two day visit he participated in a joint civil society meeting with the Lesotho Network of People Living with HIV and AIDS (LENEPWA), Lesotho Inter-Religious AIDS Consortium (LIRAC) and Lesotho Council of NGOs (LCN). The organizations stressed the need for strengthened institutional capacity and delivery of meaningful and evidence based programmes to achieve a unified response to HIV.

Mr Sidibé, addressing the participants who are openly living with HIV, said “It is because of your experience and your life that we have managed to break the conspiracy of silence surrounding HIV and AIDS.”

Mr Sidibe and Ms Caroline Ama Sande, UNAIDS Country Coordinator Lesotho were guests at a traditional Basotho performance by UN staff.
Credit: UNAIDS/G. Williams

Mr Sidibé had a meeting with UN staff and the UN Country Team followed by lunch catered by Positively Masutsa, a catering service exclusively employing HIV positive people.

An evening event hosted by acting Minister of Foreign Affairs & International Relations, Mr Semano Sekatle included the launch of the first Joint UN programme on AIDS in Lesotho. Launching the joint programme Ms Ahunna Eziakonwa-Onochie, the country’s UN Resident Coordinator said: “Lesotho deserves a unified UN that is not fragmented, that does not duplicate efforts and resources, but stands in a united front against the scourge of HIV.”

Lesotho has the third highest adult HIV prevalence in the world with 23% of those aged 15 to 49 living with HIV. Multiple sexual relationships are a major risk factor in Lesotho’s hyper endemic HIV situation.

Credit: The World Bank

Transport corridors in sub-Saharan Africa, as elsewhere, enable movement of people and goods, increasing economic activity and spreading wealth. But they also facilitate the spread of HIV. In response, the Africa Transport Sector of the World Bank has published a practical new booklet on how to implement HIV prevention activities as part of road construction projects.

The booklet, The route to good living: An overview of roles and responsibilities for HIV prevention strategies in transport sector projects, shows just why this matters. Numerous studies find relatively high HIV prevalence in this sector, especially among long-distance truck drivers. Several have shown that truckers in Kenya, Rwanda and Uganda were more than twice as likely to be living with HIV as the general population.

Many transport workers spend weeks or months away from their families, and often have multiple sexual partners, which can facilitate the spread of HIV. In Nigeria, for example, one study documented each driver having more than six sexual partners at various stops along his route. This means that people living in and around major transport hubs also have increased vulnerability. In Kenya, along the Trans-Africa Highway, high risk behaviour has been reported among boys and girls visiting truck stops and incidence of sexually transmitted infections was documented in 50 percent of the girls and 30 percent of the boys.

Credit: The World Bank

The route to good living highlights practical steps that can be taken to prevent new infections among transport workers and roadside communities, with special emphasis on road construction works. It summarizes ‘do and don’ts’ for transport ministries, World Bank teams, contractors, consultants, country project units, donors and NGOs when designing and implementing such projects. An overview of the roles and responsibilities of each set of actors within the project cycle is provided: from identification to preparation to implementation and, finally, completion. An HIV prevention strategy should be not an afterthought but an integral part of the undertaking.

The booklet is the latest addition to the information and tools available on the World Bank Africa Transport Sector's AIDS web site.

Promoting HIV prevention in the transport sector is a key component of the overall AIDS response
Credit: The World Bank

It is the result of the sub-Saharan Africa Transport Policy Programme (SSATP) encouraging discussions and collaboration among a range of partners, including the Bank, to provide concrete support in dealing with HIV. The SSATP, a unique partnership of 35 countries, eight regional economic communities, three African institutions (including the African Union/New Partnership for Africa's Development) and international partners recognizes the importance of the transport sector in achieving its goals of reducing poverty and promoting economic growth and regional integration.

In order for the transport sector to fulfill its pivotal role, the potentially devastating effects of the AIDS epidemic must be effectively challenged. The route to good living provides a concrete guide to help achieve this goal

 The Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have issued a new report on 2008 funding for global AIDS efforts from the Group of Eight nations, European Commission (EC) and other donor governments.

The latest annual report shows that overall commitments in AIDS funding from the developed world totalled US$ 8.7 billion in 2008, up from US$ 6.6 billion the previous year. Disbursements, which reflect actual resources made available in a given year and therefore provide a better measure of resource availability, rose even more rapidly, up 56 percent to reach US$ 7.7 billion in 2008.

Disbursements from the United States totaled US$ 4 billion in 2008, more than half of all disbursements and more than any other single country. The United Kingdom was the second largest donor, followed by the Netherlands, France, Germany, Norway and Sweden.

Financing a sufficient and sustained response to the AIDS epidemic in low- and middle-income countries has emerged as one of the world’s greatest health and development challenges. International assistance from donor governments, through bilateral aid and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as other financing channels, is a critical part of the response. Importantly, while the report provides the latest data available on donor funding, it reflects budgets largely set in place before the acceleration of the current global economic crisis, which may create new challenges to future funding.

1. Between 2002 and 2008, commitments and disbursements from developed nations each increased by more than five-fold.
2. In 2008, donor governments disbursed US$ 5.7 billion bilaterally and earmarked funds for HIV through multilateral organizations, as well as an additional US$ 1.7 billion to combat HIV through the Global Fund to Fight AIDS, Tuberculosis and Malaria and US$ 265 million to UNITAID.
3. When HIV disbursements are measured as a share of each nation’s gross domestic product, the Netherlands ranks first, followed by the United Kingdom, Ireland, and the United States.

Download the full report Financing the response to AIDS in low- and middle- income countries: International assistance from the G8, European Commission and other donor Governments in 2008 (pdf).

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.

UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and resources of the UNAIDS Secretariat and ten UN system organizations in the AIDS response. The Secretariat headquarters is in Geneva, Switzerland—with staff on the ground in more than 80 countries. The Cosponsors include UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. Contributing to achieving global commitments to universal access to comprehensive interventions for HIV prevention, treatment, care and support is the number one priority for UNAIDS.

The world of work is a key arena for successfully challenging the AIDS epidemic, which affects the most economically active in every population. The majority of those living with the virus across the globe are workers. To promote this challenge in Morocco, the Ministry of Employment, in collaboration with the International Labour Organization (ILO) and UNAIDS, hosted a two-day national workshop on HIV workplace programmes in Casablanca at the end of June.

Bringing together actors from a number of sectors, the meeting included representatives from trade unions, government ministries, employers and businesses, NGOs, people living with HIV, medical officers and experts. It is the first of this scale and reach to be held and over 60 discussion topics were explored.

The main aim of the workshop was to progress towards the development of a strategic AIDS plan. This three-pronged plan would include: HIV prevention in the workplace; care and support for people living with the virus and tacking stigma and discrimination; and management and coordination of the challenge to AIDS.

In order to arrive at this goal, the first day of the meeting was devoted to exploring the country's AIDS response in the world of work to date, which included a high-level discussion on challenges and lessons learned in developing HIV programmes in this sector. The principles and guidelines of the ILO, with emphasis on its Code of Practice on HIV and the world of work, adopted in 2001, were also examined.

 

It was noted that a great deal of good work had already been achieved by a number of individuals and organizations, including the Association Marocaine de Lutte contre le Sida (Moroccan Association for the Fight against AIDS - ALCS), AIDS Entreprises Morocco (a national network of companies working on HIV and STI programmes in the workplace), as well as trade unions and occupational physicians. However, all still face a number of constraints in integrating the AIDS response into the world of work.

Dr Moucharafou Idohou, the ILO National Project Coordinator in Benin, attended the Conference to present core ILO policy tools and share experience of workplace action in Francophone West Africa. He said he was pleased at progress made so far. "I congratulate the Moroccan authorities on their commitment to the AIDS response on the basis of a multi-sectoral approach and for including the workplace in this response. The initiative of developing a sectoral plan on HIV workplace programmes by the Ministry of Employment makes Morocco a pioneer country among other low prevalence countries."

While working towards the development of the strategic plan, participants took a number of areas into consideration. They debated how to move towards implementing a programme aimed at the most vulnerable, i.e. informal and mobile workers.

Also necessary would be strengthening the capacity of employers’ organizations, unions and other business institutions, while mobilizing their resources for HIV prevention and education activities and challenging stigma and discrimination. How to continue raising awareness of the human rights aspect of HIV and its impact on companies, and setting a legal framework which could serve as a basis for national AIDS programmes responding to HIV in the world of work, were also discussed.

There were a number of conclusions emerging from the workshop. The delegates recommended:

1. Setting up a national committee to focus on HIV in the workplace with representation from employers, unions and the government;
2. Development of advocacy activities to sensitize social partners;
3. Adapting the legislative framework to ensure good HIV programmes in the . workplace;
4. More research on most at risk groups;
5. Mobilization of national and international funding to implement the strategic AIDS plan.

The government of Morocco, through the Ministry of Employment, reiterated its commitment and willingness to work with its partners to effectively implement a national plan to respond to HIV and STIs in the workplace.

According to UNAIDS Country Coordinator for Morocco, Dr Kamal Alami, “The challenge to AIDS in the workplace is a key opportunity on the road to achieving universal access. We must pay special attention to the workers who are most at risk in terms of HIV infection and to the informal sector."

More than 200 participants from 54 regions of Russia discussed the strategic development of the All- Russian Union of People Living with HIV for the next two years during its first conference in June 2009.
Credit: UNAIDS

The official registration of the All-Russian Union of People Living with HIV has become a major breakthrough in the national response to AIDS in the Russian Federation. The All-Russian Union was officially registered in May 2009 and had its first conference in June 2009 under the theme “All –Russian Union of People Living with HIV: Actual Issues of Development”.

The organization has gone a long way from the first meeting in 1998 when a few people living with HIV and representatives of different public organizations gathered together and realized the need to join their efforts for a more effective work in the AIDS response. It was not an easy process to work out the mission and agree on the principles of joint work and organizational structure. Discussions, debates, fights, and reconciliations were happening parallel to real day to day work in different NGOs active in the AIDS response.

Now, the organization unites people from 50 regions of Russia. It’s based on a district principle which ensures democracy and representation in the framework of the network and consolidation of participants’ efforts.

“Our organizational mission is this: we, people living with HIV join our potential and efforts to improve the quality of life of every person affected by HIV in Russia, says Vladimir Mayanovsky, the Chairman of Coordination Council of All-Russian Union of People Living with HIV. Our organization provides an excellent opportunity to improve the involvement of people living with HIV in the national AIDS response and contribute to fight HIV at federal and regional level. We are qualified and equipped with different knowledge and skills to become the real leaders in the civil society’s response to the epidemic”.

Members of All Russian Union of People Living with HIV are active in providing prevention programmes, self support groups, palliative care, organizing special advocacy events and working with most at risk population groups. The members are divided in subcommittees which focus on different thematic areas. These subcommittees provide consultation services to thousands of people living with HIV in Russia.

Members of the Union also advocate to addressing urgent issues such as the lack of confidentiality for children living with HIV in primary school care and medical institutions or the law that does not allow people living with HIV to adopt children. Members of All –Russian Union of People Living with HIV cooperate with penitentiary system and provide social support to people released from prisons.

Local branches of the Union have also initiated new projects in their areas. For example, one branch in Dagestan introduced a special educational course on HIV prevention at Dagestan Social University which is being implemented by one of the members of the Union. The branch in Volgograd opened a hotline that provides quality information on AIDS issues. The branch in Khanty-Mansiysk federal region, which is one of the regions most affected by HIV in Russia, provides assistance in accessing antiretroviral treatment to those in need. In Siberia another union member initiated HIV testing in remote areas by inviting medical professionals from regional AIDS Centers to go there.

Dr.Larisa Dementyeva, a representative from the Department on HIV/AIDS of the Russian Federal Service of Surveillance Over Consumer Rights Protection and Human Well-Being welcomed the All-Russian conference of People Living with HIV in Russia.

“Members of All Russian Union People Living with HIV are knowledgeable and enthusiastic young people, said Dr. Dementyeva. We consider the Union as our partner in meeting the needs of people living with HIV. The Union plays a very significant role in raising awareness about HIV prevention, reducing stigma and promoting tolerance.”

More than 200 participants from 54 regions of Russia discussed the strategic development of the All- Russian Union of People Living with HIV for the next two years and adopted the resolution of the meeting.

“The All- Russian Union of People Living with HIV has strong leadership, transparent structure, partners in government and civil society. The organization has a huge potential. We consider it as one of our leading partners in civil society in strengthening HIV responses at national level”, said Dr. Marina Semenchenko, UNAIDS Team Leader a.i. in Russia.

Michelle Obama visited the St. Dimitry Sisterhood Medical Nurses College in Moscow.
Credit: UNDP/Andrei Radkevich

US First Lady Michelle Obama visited St. Dimitry Sisterhood Medical Nurses College in Moscow, a nursing school that cares for people living with HIV on 7 July. While there, she stressed the need for more information and education to reduce stigma and raise awareness about how to care for people living with HIV. Ms. Obama, who worked previously as an executive for University of Chicago Hospitals, also shared her experience in the health care field and noted the importance of the work.

Created in 1992, the college trains nurses to care for people living with HIV as part of a larger UNDP project funded by USAID. St. Dimitry Sisterhood and Medical Nurses College aims to contribute to the decrease in HIV and AIDS incidence in the Russian Federation and mitigate the impact of the epidemic on the population by involving the Russian Orthodox Church in the prevention of the spread of the epidemic, reduction of stigma and discrimination, and provision of care and support to people living with HIV and affected by AIDS.

Sister Olga, project coordinator, emphasized that many more people, including youth and children, need this kind of support. “Our sisters are helping families with HIV-positive members as well as HIV-positive children living in orphanages,” she said.

UNDP works to prevent the spread of HIV and reduce the impact of AIDS. As a trusted development partner, and cosponsor of UNAIDS, it helps countries put HIV at the centre of national development and poverty reduction strategies; build national capacity to mobilize all levels of government and civil society for a coordinated and effective response to the epidemic; and protect the rights of people living with HIV, women, and vulnerable populations. Because HIV is a worldwide issue, UNDP supports these national efforts by offering knowledge, resources and best practices from around the world.

For more information, visit hivrussia.ru (in Russian) and the UNDP Russia Web site.

A version of this story was written by Faryal Mirza, Universal Postal Union (UPU)

(Left to right) Mr Philip J. Jennings, General Secretary of UNI Global Union, Mr Edouard Dayan, Director General of the Universal Postal Union, Mr Michel Sidibé, Executive Director of UNAIDS and Mr Assane Diop, Executive Director of the Social Protection Sector at ILO during a press conference to launch the Global prevention awareness campaign at the Palais des Nations in Geneva, Switzerland on 7 July 2009.
Credit: UNAIDS/O. O'Hanlon

Halting the spread of HIV by 2015 is one of the United Nations Millennium Development Goals (MDGs). To contribute towards this goal, the Universal Postal Union (UPU) and UNAIDS together with the International Labour Organization (ILO) and UNI Global have launched a global awareness campaign. Post offices in participating countries will display HIV prevention information which will reach the general public and postal employees.

“This awareness-raising campaign is part of the UPU’s ongoing effort to promote sustainable development and social responsibility among postal operators,” says UPU Director General Edouard Dayan.

Global reach

In many parts of the world, post offices already have a social role by promoting public health messages within their community. At the heart of the campaign is the Posts’ unrivalled physical network of 660,000 post offices. Alison Phillips-Pearce, the UNAIDS campaign coordinator, is excited by the “enormous outreach” of the joint initiative. Also, the network has a special characteristic. “The Post is a place that is open to everyone from the young to the old and does not discriminate,” Phillips-Pearce adds.

Claude Montellier, head of the sustainable development programme at the UPU, believes there is the potential for Post Offices to do much outreach given that they already provide universal access to information. He added that this led the UPU to consider ways the postal network could benefit the public at large.

“Promoting social responsibility takes place through the development of awareness programmes about diseases for postal staff and the public,” he said.

UNAIDS created the bold advocacy materials for this campaign, including posters, postcards and country fact sheets.

Consultative process

For UNAIDS’ part, Phillips-Pearce shed light on why the campaign materials had taken their chosen form. “The materials were the outcome of a consultative process with our partners.” The materials were tested on a global audience and across genders to find out if the message was clear. The end result was the slogan: “Your post office cares. Protect yourself.”

“An adaptable slogan was needed to ensure that the message was meaningful to the country it is displayed in,” Phillips-Pearce said. In Brazil, for example, a more direct message was required, so the slogan on campaign materials there will read: “Your post office cares. Protect yourself. Wear a condom.”

First phase: Brazil, Burkina Faso, Cameroon, China, Estonia, Mali and Nigeria

As a first phase the campaign will reach out to postal customers of seven countries— Brazil, Burkina Faso, Cameroon, China, Estonia, Mali and Nigeria. These were chosen because of their HIV prevalence rates and to give a broad geographical spread. Estonia, for example, has Europe’s highest rate of HIV infection. During this initial phase, nearly 24,000 post offices will display and distribute the information materials and more UPU member countries will join later this year.

The campaign’s second phase in 2010 will focus on postal employees with help from the ILO and UNI Global Union. The ILO will prepare a toolkit for postal employers to use to inform their staff about HIV and UNI Global hopes to have the support of both the Posts and the workers’ unions for this phase.

Thirdly, in 2011, the UPU plans to invite its member countries to issue a stamp to commemorate the discovery of AIDS in 1981 when the first scientific article related to this disease was published.

“AIDS touch the lives of a very large part of our population”

Meanwhile, with the launch of the campaign the Cameroon Post is hoping that its 220 outlets will make an impact in the country where around five per cent of adults between 15 and 49 are living with HIV.

It is the first time that Mireille Ndancha Njilla, a postal operator, has participated in a health campaign, however she believes that there is a need to raise awareness of the virus in her community, as “HIV and AIDS touch the lives of a very large part of our population.”

According to Justices Shah and Muralidhar, the Constitution of India recognizes, protects and celebrates diversity.

The Delhi High Court declared section 377 of the Indian Penal Code which criminalised consensual sexual acts of adults in private as violative of the rights to privacy, liberty, health and equality enshrined in the Constitution of India. Though the decision was largely seen as a victory for the men who sex with men and transgender people, it is a victory for all – regardless of sexual orientation and gender identity. The judgment is noteworthy and progressive in terms of its rejection of a hetero-normative and homogenous conception of sexuality. According to Justices Shah and Muralidhar, the Constitution of India recognizes, protects and celebrates diversity.

Justice Edwin Cameron of South Africa’s Constitutional Court speaking at a meeting of men who have sex with men in Kathmandu, Nepal said, “Admittance of gays and lesbians is the ultimate measure of a society’s capacity to view humanity in its fullness and of its commitment to equality, justice, secularism, and humane co-existence.” This judgement has propelled India’s AIDS response and human rights movement a giant leap forward in this direction.

"The Delhi High Court has restored the dignity and human rights of millions of men who have sex with men and transgendered people in India,” said UNAIDS Executive Director Mr Michel Sidibé. “Oppressive laws such as Section 377, drive people underground making it much harder to reach them with HIV prevention, treatment and care services.”

Justices Shah and Muralidhar’s judgment is evidence informed and grounded in human rights drawing its argument from case law from India and around the world, international declarations and commitments, scientific studies and UNAIDS policies.

In its affidavit before the judges, India’s National AIDS Control Organization (NACO), taking a opposite stand from that of the interior ministry contended that section 377 has hampered HIV prevention efforts. NACO cited that only 6% of all men who have sex with men have access to HIV prevention, treatment, care and support services, as most of them are reluctant to reveal their same sex behaviour due to fear of extortion, harassment, and violence at the hands of law enforcement authorities. It was noted that section 377 encourages people to remain hidden - making it difficult for them to access essential HIV, health and social services.

According to Jeffrey O’Malley, Director of UNDP’s HIV Practice, “Inappropriate criminalization is a major impediment to achieving universal access. This landmark judgment emphasizes the importance of improving the human rights situation for men who have sex with men and transgender people across the globe. We hope that other countries will follow suit. The realization of human rights for all is not only fundamental to our common humanity, it also is imperative for an effective AIDS response and generating broader health and development benefits.”

According to Justices Shah and Muralidhar, the criminalization of homosexuality condemns in perpetuity a sizable section of society and forces them to live their lives in shadow of harassment, exploitation, humiliation, cruel and degrading treatment at the hands of the law enforcement machinery. The judges referred to Article 12 of the Universal Declaration of Human Rights which states, "No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks."

The judges concluded that to stigmatize or to criminalize homosexual only on account of their sexual orientation would be against constitutional morality. The judgment held that morality cannot be held as a ground for restriction of fundamental human rights. Justices Shah and Muralidhar concluded that “while it could be “a compelling state interest” to regulate by law, the area for the protection of children and others incapable of giving a valid consent or the area of non-consensual sex, enforcement of public morality does not amount to a “compelling state interest” to justify invasion of the zone of privacy of adult homosexuals engaged in consensual sex in private without intending to cause harm to each other or others.” The judges quoted a leading Indian luminary, Justice Krishna Iyer who said, “... The compulsion of constitutional humanism and the assumption of full faith in life and liberty cannot be so futile or fragmentary that any transient legislative majority in tantrums against any minority by three quick readings of a Bill with the requisite quorum, can prescribe any unreasonable modality and thereby sterilise the grandiloquent mandate.”

In their conclusion, the judges drew from one of the key principles of the Indian Constitution—inclusiveness. “If there is one constitutional tenet that can be said to be underlying theme of the Indian Constitution, it is that of 'inclusiveness'. This Court believes that Indian Constitution reflects this value deeply ingrained in Indian society, nurtured over several generations. The inclusiveness that Indian society traditionally displayed, literally in every aspect of life, is manifest in recognising a role in society for everyone. Those perceived by the majority as “deviants' or 'different' are not on that score excluded or ostracised. Where society can display inclusiveness and understanding, such persons can be assured of a life of dignity and nondiscrimination. Justices Shah and Muralidhar held that Indian “constitutional law does not permit the statutory criminal law to be held captive by the popular misconceptions of who the lesbians, gay, bisexuals, and transgender people are. It cannot be forgotten that discrimination is antithesis of equality and that it is the recognition of equality which will foster the dignity of every individual.”

In the 2006 United Nations Political Declaration on HIV/AIDS, governments committed to removing legal barriers and passing laws to protect vulnerable populations. Evidence shows that countries which have laws to protect men who have sex with men, injecting drug users and sex workers have provided better access to HIV prevention, treatment, care and support. UNAIDS along with UNDP, the lead Cosponsor, focusing on expanding and strengthening policies and programmes for men who have sex with men, transgender people and HIV, will support countries in removing laws that block effective AIDS response and increasing access to HIV prevention, treatment, care and support.

UNAIDS urges all governments to ensure full respect for the human rights of men who have sex with men, lesbians and transgender people through repealing laws that prohibit sexual acts between consenting adults in private; enforcing laws to protect these groups from violence and discrimination; promoting campaigns that address homophobia, transphobia and stigma, and ensuring that essential health and social services and support are available and accessible.

 A joint Word Bank/UNAIDS report looks at the potential impact of the global financial crisis on HIV prevention and treatment programmes worldwide. Using data collected in March 2009 from 71 countries, the analysis looks at how the crisis could affect the nearly 4 million people living with HIV on treatment, and the 7 million who need treatment but don’t have access to it, and proposes some appropriate responses. The potential effects on prevention activities were also investigated. The report suggests that the well-being of millions of people could be put at risk.

The financial crisis started in the most-developed economies, but its impact has been felt in virtually all nations, leading to fears that donor assistance will remain flat or be cut, the budgetary revenues of developing countries will fall and worker remittances will decline. Many households may experience increased mortality and morbidity if the commitments made by the international community to sustain and increase access to antiretroviral treatment are not honoured and/or government expenditures on AIDS are reduced.

The report notes that an important lesson learned during previous crises is that cuts in core social development spending have long-term negative effects. Responding to fiscal pressures by reducing spending on HIV will reverse recent gains and require high-cost offsetting measures over the longer term.

Treatment at risk

At present, nearly 4 million people are on antiretroviral treatment in the countries surveyed. Many more, however, would benefit if treatment were made available to them. Combination antiretroviral treatment, typically three drugs taken daily, suppresses levels of HIV (the ‘viral load’) in the blood to undetectable levels and halts progressive damage to the body’s immune system. By taking the drugs as prescribed, people living with HIV can stay healthy, well and productive. However, if there are interruptions in taking the drugs, for example because of cutbacks in funding for AIDS treatment programmes, HIV replication is no longer suppressed and life-threatening conditions will develop, drug resistance will increase and there will be an increased potential for HIV transmission.

The report describes how respondents in 11% of the countries surveyed (home to 427,000 people on treatment) reported that the global crisis had already affected treatment programmes in their countries. Respondents in 31% of countries, with 1.8 million people on treatment, reported that they expect impacts on treatment this year, while 30% of countries were unsure if treatment would be affected. Programmes were found to be especially vulnerable in sub-Saharan Africa, eastern and central Europe and the Caribbean.

Programmes are vulnerable for a variety of reasons, including declining household incomes (in Africa, for example, household out-of-pocket spending accounts for up to 60% of total health expenditures) and uncertain external aid assistance, but the report notes that the effects would be the same whatever the reason for programme curtailment: increased mortality and morbidity, greater transmission risks, higher financial costs in the long run and an increased burden on health systems as more ill people crowd public hospitals.

Prevention

For every two people accessing HIV treatment, another five people are becoming infected with HIV. Preventing new infections is therefore key to responding to the epidemic. However, the survey discovered that in 34 countries, where 75% of people with HIV live, prevention programmes for populations at higher risk are forecast to be affected. Programmes for these populations seem to be at risk because they are politically easier to cut; however, the consequences would be severe: less prevention that results in more new infections will mean greater future treatment needs, with large cost implications.

Responding to the crisis

While the results of the survey are worrying, the report does give recommendations on interventions that could help to address the crisis. Using existing funding better by moving resources from low-impact to high-impact programmes and addressing urgent funding gaps are highlighted as measures that should be taken. Monitoring systems, including for treatment interruptions, and the importance of planning for an uncertain environment are other issues that need to be given attention.

ECOSOC events are organized in the Economic and Social Council Chamber.
Credit: ECOSOC

The high-level segment of the annual session of the Economic and Social Council (ECOSOC) opened this morning in Geneva with addresses by Sylvie Lucas, President of the Economic and Social Council; Ban Ki-moon, Secretary-General of the United Nations and Hans-Rudolf Merz, President of Switzerland.

The focus of the 2009 Annual Ministerial Review (AMR), which takes place during this high-level segment of ECOSOC will focus on "Implementing the internationally agreed goals and commitments in regard to global public health."

UNAIDS Executive Director Michel Sidibé participated in a session this afternoon on “Partnerships in health – lessons from multi-stakeholder initiatives.”

Mr Sidibé spoke about the prominent role of partnerships in the success of the AIDS response and the importance of collaboration with civil society, faith-based groups and the private sector as “partnerships are the life blood of the AIDS response.”

“People affected by HIV have always been at the heart of the response,” said Mr Sidibé. He also called for a broadened vision, an “AIDS+MDG movement” to address global health and development challenges.

He was joined on the panel by Philippe Douste-Blazy, Special Advisor on Innovative Financing for Development and Chair of the Board of UNITAID Michel Kazatchkine, Executive Director, Global Fund to Fight Aids, Tuberculosis and Malaria.

On Tuesday, Mr Sidibé will participate in a satellite on injecting drug use and a ministerial meeting on AIDS vaccines.

The high-level segment is a forum for Ministers and executive heads of international institutions and high-ranking officials, as well as civil society and private sector representatives to discuss key issues on the international agenda in the area of economic, social and environmental development.

It provides an opportunity to:
1. Assess the state of implementation of the United Nations Development Agenda;
2. Explore key challenges in achieving the international goals and commitments in the area of global public health;
3. Consider recommendations and proposals for action, including new initiatives.

The Economic and Social Council

ECOSOC was established in 1945 under the United Nations Charter as the principal organ to coordinate economic, social, and related work of the 14 UN specialized agencies, functional commissions and five regional commissions. The Council also receives reports from 11 UN funds and programmes. It serves as the central forum for discussing international economic and social issues, and for formulating policy recommendations addressed to Member States and the United Nations system.

The gathering runs until 9 July at the Palais des Nations in Geneva, Switzerland.