The AIDS Ambassadors discussed ways in which to strengthen their roles to contribute to the achievement of the Millennium Development Goals. Credit: UNAIDS/Donang Wahyu

Ahead of the official opening ceremony of the 9 th International Congress on AIDS in Asia and the Pacific (ICAAP), a high-level meeting of AIDS Ambassadors took place in Bali. The gathering was co-hosted by the First Lady and National AIDS Ambassador of Indonesia, Mrs Ani Bambang Yudhoyono, and AIDS Ambassador of Australia, Mr Murray Proctor.

The AIDS Ambassadors meeting addressed the need for leadership in the Asia and Pacific Region and the ways in which Ambassadors can have a greater effect in reducing the spread and impact of HIV.

The AIDS Ambassadors discussed ways in which to strengthen their roles to contribute to the achievement of the Millennium Development Goals. They also discussed ways to address challenges, including better donor coordination, programs to address gender power imbalances, promoting an agenda for youth and recognition of the development impacts of the epidemic.

The UN Secretary-General’s Special Envoy for HIV/AIDS in Asia and the Pacific Dr Nafis Sadik also participated in the event together with, among others, the First Lady of Cambodia, Madame Bun Rany Hun Sen, Lady Roslyn Morauta, AIDS Ambassador and Former First Lady of Papua New Guinea , the AIDS Ambassador from the Netherlands, Dr Wijnroks, UNAIDS Director, Regional Support Team for Asia and the Pacific, Mr JVR Prasada Rao, UNFPA Deputy Executive Director, Purnima Mane and UNAIDS Goodwill Ambassador Salman Ahmed whom participated in the dialogue as an advocate for youth, emphasizing the role they can play in leading HIV prevention efforts.

The high-level meeting of AIDS Ambassadors was co-hosted by the First Lady and National AIDS Ambassador of Indonesia, Mrs Ani Bambang Yudhoyono (in the image), and AIDS Ambassador of Australia, Mr Murray Proctor. Credit: UNAIDS/Donang Wahyu

In order to translate their commitment to reducing the spread and impact of HIV into action, delegates endorsed a joint statement that was then delivered by Indonesia’s First Lady, H.E. Ibu Ani Bambang Yudhoyono at the 9th ICAAP Opening Ceremony.

In the statement, AIDS Ambassadors called on Governments, donor organizations and all community partners to support and maintain HIV programmes with the goal in mind of reaching universal access to comprehensive prevention, care, support and treatment for as well as sustaining progress in implementing the Declaration of Commitment adopted at the UN General Assembly Special Session on AIDS in 2001, despite the pressures of the global economic crisis.

HIV epidemic in Asia and Pacific

According to the Independent Commission on AIDS in Asia (2008), AIDS remains the most likely cause of death and loss of work days among people aged 15 to 44.

An estimated 5 million people in Asia were living with HIV in 2007 according to 2008 report on the global AIDS epidemic. The several modes of HIV transmission present in the region, via sex work, injecting drug use, and unprotected sex between men; make Asia’s epidemic one of the most diverse in the world. The Pacific region’s epidemics are relatively small with an estimated 74 000 people living with HIV across Oceania in 2007.

The 10 UNAIDS Cosponsors are presenting a strong showing as thousands of delegates converge in Bali, Indonesia, to share ideas, knowledge, best practices, lessons learned and research findings at the 9th International Congress on AIDS in Asia and the Pacific (ICAAP).

The Cosponsors are an integral part of the UN’s response to the global AIDS epidemic and UNAIDS brings together their efforts and resources.

Echoing the Congress theme, ‘Empowering people - strengthening networks’, the Cosponsors are organising and presenting symposia, skills-building workshops and satellite meetings drawing together a number of participants from a range of disciplines with the aim of helping to build and nurture partnerships to bolster the AIDS response in the region.

A number of events are joint Cosponsor initiatives. For example, the Symposium on ‘HIV prevention and most at risk young people’, taking place on 10 August, is sponsored by UNFPA, UNICEF, UNESCO, UNDP, WHO and UNAIDS. The symposium, hosted by the Asia Pacific Regional UN Coordination Group on Most at Risk Young People, is designed to look at the specific needs of this population which is, in general, not being reached by HIV prevention services. This includes injecting drug users, men who have sex with men and sex workers and their clients. Representatives from these groups will also take part in the panel discussion –one further example of how Cosponsor ICAAP activities are designed to involve key populations.

Other examples of Cosponsor activities include UNDP, ILO and UNAIDS (with the Joint United Nations Initiative on Mobility and HIV/AIDS in South East Asia) collaborating on a joint symposium on 12 August entitled, ‘The Impact of the Financial Crisis on Labour Migration and HIV’ in which they will bring their respective expertise to bear on this pressing international issue. UNHCR, along with UNAIDS, is hosting a satellite session on 12 August called ‘Opportunities and challenges in addressing HIV amongst diverse humanitarian populations’. WFP will use a satellite session on 11 August to explore the vital role of nutrition and food security for people living with HIV and will, along with its partners, look at ‘Models for integrating nutrition and food security into HIV care, support and treatment in the Asia Region: Opportunities and challenges’.

The World Bank is also championing the screening, on 10 August, of the film, Suee (Needle) by Cannes Film Festival award winner, Sai Paranjpye, which deals with the lives of injecting drug users and the anti-AIDS stigma they face. The film emerged from the South Asia Region Development Marketplace, a grant programme spearheaded by the Bank and supported by a range of partners including UNAIDS, UNICEF, UNODC and UNDP.

There is an extremely broad range of other Cosponsor activities taking place over the five days of the Congress and a number of these events will be highlighted on the UNAIDS website as the ICAAP progresses.

UNAIDS and its ten Cosponsors work to provide technical support to countries to assist them in the implementation of their national AIDS plans. A ‘division of labour’ guides the technical support provided to enhance coordination, avoid duplication and provide the best assistance available. Each of the Cosponsor organizations leads in at least one technical area. These organizations are:

Office of the United Nations High Commissioner for Refugees (UNHCR)

United Nations Children's Fund (UNICEF)

World Food Programme (WFP)

United Nations Development Programme (UNDP)

United Nations Population Fund (UNFPA)

United Nations Office on Drugs and Crime (UNODC)

International Labour Organization (ILO)

United Nations Educational, Scientific and Cultural Organization (UNESCO)

World Health Organization (WHO)

World Bank

A new shared blog for the development community

The burning issues in the world today demand discussions among the whole UN family and the development community. This is why the UNFPA, the United Nations Population Fund, is launching a series called Conversations for a Better World. It is based on the idea that if the AIDS epidemic and other key development issues are to be dealt with effectively, greater attention has to be paid to population dynamics and reproductive health. The idea is to activate informed discussion and debate.

Conversations for a Better World is a shared blog, where people can express and exchange ideas and opinions on development issues. Each month the blog will have an editorial focus on one major topic.

“Poverty and AIDS: What really drives the epidemic?” is the conversation topic that launches 6 August and includes various opinion pieces and blog-posts related to the complicated relationship between lack of access to resources and HIV. The previous conversation topic was “Women and the Economic Crisis.”

Conversations for a Better World is based on ‘the power of we’: the idea that when it comes to addressing complex challenges, collective wisdom is called for. Anyone can contribute by uploading personal stories, relevant photos or videos and comments or opinion pieces.

“We’re hoping to engage discussion from experts as well as people who are directly impacted by these issues,” said Neil Ford, chief of the Media and Communications Branch of UNFPA. “We know that many visitors to the UNAIDS website are very knowledgeable about AIDS and poverty, and we encourage them to register and share their opinions and insights. That’s what ‘Conversations’ is all about.”

Not afraid to be provocative, subsequent Conversation topics will pose a number of questions over the coming year. These will include:
1. September 2009: Young People and Times of Change: Talking about life, love and sexuality
2. October 2009: Motherhood and Human Rights: Do all pregnant women have the right to live?
3. November 2009: Population Dynamics and Climate Change: Who’s at the centre of the storm?
4. December 2009: Sexual Violence and Progress: What are the real costs?
5. January 2010: Women and Hunger: Who feeds the family, and how?
6. February 2010: Migration and Prosperity: What’s fair?

You are invited to share your opinion. Start by going to www.conversationsforabetterworld.com Then, feel free to register and join the conversation!

Ministers of Education and Health in Latin America and the Caribbean and other officials during the First Meeting of Ministers of Health and Education to stop HIV/AIDS in Latin America and the Caribbean. Mexico City, 1 August 2008.
Photo credit: agencialibrefoto

A year ago Latin America and the Caribbean Ministers pledged to provide comprehensive sex education in schools. The historic Prevention through education declaration was signed at the end of the First Meeting of Ministers of Education and Health to prevent HIV in Latin America and the Caribbean.

The Ministers committed to promoting concrete actions for HIV prevention among young people in their countries by implementing sex education and sexual health promotion programmes.

The declaration noted that “Sexuality is an essential part of being human and it is expressed throughout ones lifetime. Childhood and adolescence are important periods for the development of people and their countries, and for this reason, it is necessary to provide quality education that includes comprehensive education on sexuality both as a human right, as well as one that contributes to present and future quality of life.”

The Ministers also committed to two specific targets:

1. By the year 2015, we will have reduced by 75% the number of schools that do not provide comprehensive sexuality education, of schools administered by the Ministries of Education.
2. By the year 2015, we will reduce by 50% the number of adolescents and young people who are not covered by health services that appropriately attend to their sexual and reproductive health needs.

The 1 August meeting took place in Mexico City and was co-hosted by Dr José Ángel Córdova Villalobos (México), Minister of Health and Lic. Josefina Vázquez Mota (Mexico), Minister of Public Education in collaboration with Canciller Patricia Espinosa Cantellano (México), Minister of Foreign Affairs.

The event led to renewed commitment to education to prevent HIV in both Latin America and the Caribbean regions. Thanks to the declaration a new agreement was signed earlier this year in San Jose by the Government of Costa Rica which will lead in the sharing of sexual health information among young people, aged 15 – 25 years in two provinces. The young leaders will provide education on a wide range of issues such as modes of HIV transmission and how to use a condom.

Dr César Nunez, UNAIDS Regional Director for Latin America, points out that young people aged 15-24 accounted for 45% of all new HIV infections in 2007, however only 40% of young people aged 15-24 had accurate knowledge about HIV and transmission.

“Effective sexuality education can provide young people with age-appropriate, accurate and sensitive information equipping them to make informed decisions. Governments in Latin America and Caribbean are showing increasing leadership in this area.”

The United Nations Economic and Social Council (ECOSOC) has for the first time awarded consultative status to a Latin-American non-governmental organization representing the rights of lesbian, gay, bisexual and transgender communities. The organization, the Brazilian national Lesbian, Gay, Bisexual and Trans Association (ABGLT), will now be able to present oral and written reports at UN meetings and organize events on UN premises.

The ABGLT has said that its primary goal will be to highlight injustices around the world faced by the lesbian, gay, bisexual and transgender community, particularly in the 80 countries in the world have legislation that prohibits same sex behaviour.

UNAIDS welcomes the decision by ECOSOC and fully supports the rights of the lesbian, gay, bisexual and transgender community. UNAIDS works closely with such organizations in the AIDS response and will continue to promote human rights and fundamental freedoms for people living with HIV and those more vulnerable to HIV infection.

“Phones for Health” is a partnership between a healthcare software provider Voxiva, a phone producer Motorola, a telecom company MTN, the GSMA Development Fund, PEPFAR, CDC Foundation, Accenture Development Partnerships and several governments. The integration of mobile technology and health applications enables health workers on the road to input and transfer health data to a central database where the data can be analysed. In addition, they can order medicines, send alerts, download guidelines, or access training materials.

This is one of several public-private initiatives showcased in a new UNAIDS report that looks at the contribution of AIDS-related public-private partnerships* to the six building blocks of health systems: service delivery; human resources; information; medicines and technologies; financing; and leadership.

HIV-related Public-Private Partnerships and Health Systems strengthening, highlights how the AIDS response has been a strong catalyst in the establishment of public-private partnerships for health, particularly in Africa. Many of these partnerships initially focused on HIV but they later expanded to cover wider health issues.

“This publication is innovative as it approaches public-private partnerships via a very specific angle: their applicability to strengthen the public sector,” said UNAIDS Private Sector Partnerships Chief, Regina Castillo. “We hope the report will provide some guidance on critical steps private and public actors need to take to maximize the potential of public-private partnerships for the benefit of public health,” Ms Castillo added.

UNAIDS has noted in its Outcome Framework 2009-2011 that substantial progress on a number of the Millennium Development Goals can be achieved by taking the AIDS response out of isolation and integrating it with efforts to achieve broader human development including the goal of health.

Research and interviews with representatives of private and public organization stakeholders as well as development partners were carried out. Twelve public-private partnerships with a strong collaborative relations with government institutions in the country of implementation were identified to present insider perspectives on catalysts and hurdles which may be encountered in developing collaborations. Good practices have been identified taken into consideration their sustainability, their integration in the national AIDS control plan, their measurable results, etc.

Some of the partnerships presented in the publication include North Star Foundation, BD’s Wellness Centres relieving the pressure on nurses in sub-Saharan Africa, DataDyne and Vodaphone Foundation developing health surveys with EpiSurveyor, Abbott Fund’s laboratory support from national to regional level in Tanzania, Mars supporting the National Health Insurance Scheme of Ghana, Fondation Sogebank managing Global Fund grants as Principal Recipient in Haiti, etc.

The topic of public-private partnerships was the focus of a breakout session of the Thematic Segment of the 23rd UNAIDS Programme Coordinating Board Meeting in Geneva on 15 December 2008. UNAIDS governing board then commissioned the Secretariat to compile “best practices and lessons learnt to support and facilitate public-private partnerships with respect to their applicability for strengthening the public sector in low and middle income countries”. “HIV-related Public-Private Partnerships and Health Systems Strengthening” is the result from this process.

To receive printed copies of the report, please contact Marie Engel, email engelm@unaids.org

* A Public-Private Partnership is defined as an “institutional relationship between the state and the private profit and/or the private non-profit sector, where the different public and private actors jointly participate in defining the objectives, methods and implementation of an agreement of cooperation”.

Credit: ECOSOC

The UN Economic and Social Council (ECOSOC) passed a resolution on UNAIDS by consensus at its 2009 substantive session on 24 July. Negotiations on the text were led by the Delegation of the Netherlands, in its capacity as Vice Chair of the UNAIDS Programme Coordinating Board and ECOSOC member, and 31 countries – from all regions – co-sponsored the text.

The resolution welcomes the UNAIDS Outcome Framework as a tool for achievement of the goal of universal access and its emphasis on the prevention of sexual transmission. Moves to leverage AIDS to respond to broader health and development agendas, in particular the health Millennium Development goals (MDGs) – through the removal of socio-economic and legal barriers, and the maximum use of flexibilities under the TRIPS agreement to provide access to affordable antiretroviral drugs of assured quality – were applauded as central to the mandate of UNAIDS.

ECOSOC urged all member states to eliminate HIV-specific restrictions on entry, stay and residence, and for all stakeholders to come together at the country level to develop transparent, accountable and effective national responses within the “Three Ones” principles. Ongoing financial and political support for research and development of prevention technologies – including an effective HIV vaccine – was needed.

Recognition was also given to the need for the Joint Programme to significantly expand and strengthen its work to address the gap in services for injecting drug users in all settings. Barriers to the response continue and partnerships in addressing them will be key – as outlined in the welcome UNAIDS Action Framework: Universal Access for Men Who Have Sex With Men and Transgender People.

In recognizing the interrelated nature of the health and gender-related MDGs, Member States welcomed the ongoing development and operationalization of an Action Framework addressing women, girls, gender equality and HIV, under the leadership of the UNAIDS Executive Director.

At country level, efforts were encouraged to strengthen the UNAIDS technical support division of labour, and the concept of a joint United Nations team and programme on AIDS, with the aim of harmonizing technical support, strengthening programmatic coherence and improving the collective accountability of the United Nations system. UNAIDS ongoing role in the process of UN reform, and in the delivery of broader United Nations development assistance – was recognized and encouraged.

Finally, ECOSOC welcomed the submission by Member States of a total of 147 country progress reports in 2008, as part of the reporting process established by the Declaration of Commitment n HIV/AIDS, which had provided the most comprehensive overview to date of the response at country level, and encouraged all Member States to fully support the next round of reports due on 31 March 2010.

(from left) Norwegian AIDS Ambassador Sigrun Mogedal and Michel Sidibé, UNAIDS Executive Director
Credit: UNAIDS

When the Executive Director of UNAIDS took office he called for a renewed commitment to universal access. From January to May 2009, a transition team led by Norwegian AIDS Ambassador Sigrun Mogedal engaged in a process of consultations and dialogue with key partners and stakeholders in the HIV response to obtain insight on where UNAIDS should focus its efforts in helping countries achieve universal access to HIV prevention, treatment, care and support.

More than a thousand people were consulted in this extensive exercise, from Programme Coordinating Board (PCB) members, UNAIDS Cosponsors, to The Global Fund to Fight AIDS, TB and Malaria, civil society partners, including people living with HIV, the private sector and foundations.

“Ambassador Mogedal fostered open dialogue during the transition. For her enormous contribution I am very grateful,” said Michel Sidibé, UNAIDS Executive Director. “The information gathered by the Dialogue process gives valuable insights to the organization as we move forward,” he added.

The wide consultative process enabled invaluable exchanges of opinions. The report Dialogue on Universal Access 2009 highlights the main findings and proposes a number of areas of focus and recommendations for UNAIDS to lead a more effective AIDS response.

The information gathered from the consultations became a primary source of inputs for the UNAIDS Outcome Framework: Joint Action for Results 2009–2011, which provides guidance for Cosponsors and the Secretariat.

Visit the e-Dialogue website to access weekly discussions, resources and consultation documentation, 

An estimated 4 million people in low- and middle-income countries were receiving antiretroviral therapy (ART) at the end of 2008, compared to 3 million in 2007 and 400,000 in 2003, according to preliminary data compiled by WHO, UNAIDS and UNICEF. Approximately 285,000 children benefited from paediatric ART programmes in 2008, a 45% increase over the prior year. In sub-Saharah Africa, nearly 3 million people were accessing treatment in 2008, a 38% increase over 2007.

These and other figures—presented at the International AIDS Society conference in Cape Town—are based on an analysis of data collected from 127 low- and middle-income countries. In collaboration with countries, WHO, UNAIDS and UNICEF are still completing the analysis. Final figures on ART access will be published in the September 2009 "Towards Universal Access" progress report, together with an in-depth analysis of a broad range of health sector HIV/AIDS interventions.

Substantial progress has been made in increasing access to treatment in low and middle income countries. Some countries have already achieved their universal access goals for treatment. However in other countries, the rate of scale up is not sufficient to achieve their national targets for 2010.

Some of the factors hindering progress include weak and fragmented health systems that are not sufficiently decentralized, poor integration of health services, poor access to HIV testing and counselling services, pervasive stigma and discrimination. These constraints are further affected by the recent economic crisis. WHO, UNICEF and UNAIDS together with partners and implementers, are working on responses for countries to overcome the obstacles.

"Towards Universal Access" is an annual report that monitors the health sector response to HIV/AIDS. To access the 2008 report, please visit the following link.

Credit: WHO

According to a new study led by the World Health Organization (WHO), if HIV-positive pregnant women are given a combination of antiretroviral (ARV) drugs from late in pregnancy until six months into breastfeeding, rather than a short course of drugs that ends at delivery, their babies are over 40% less likely to become infected with HIV.

The initial findings of the study, named Kesho Bora, which means ‘a better future’ in Swahili, were presented at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention taking place in Cape Town, South Africa, 19-22 July. WHO worked in partnership with the French National Agency for Research on AIDS and Viral Hepatitis (ANRS), the US Centers for Disease Control and Prevention (CDC) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the US National Institutes of Health.

Carried out between June 2005 and August 2008, involving 1,140 women at five sites across Africa (in Burkina Faso, Kenya and South Africa), the purpose of Kesho Bora was to assess whether the risk of passing on HIV during breastfeeding could be reduced.

It shows that a significant reduction in infant infection can be achieved when pregnant women with a CD4 immune cell count of 200-500 cells/ mm3 are given a combination of three ARVs to prevent transmission: starting in their last trimester of pregnancy, continuing through birth and six months of breastfeeding. This was shown to reduce the risk of transmitting HIV to the baby and improved survival compared with babies of mothers with HIV who are given the current WHO-recommended short-course ARV regimen in late pregnancy and around the time of delivery.

The best results in the study were recorded in the group of mothers enrolled with a CD4 count between 200 and 350 cells/mm3. There is no increased risk to the health of the mother or the infant associated with this triple-ARV regimen, consisting of zidovudine, lamivudine and lopinavir/ritonavir. The study did not randomize women with CD4 counts below 200 cells/ mm3 as these women require treatment for their own health. That treatment also substantially reduces the risk of transmitting HIV during breastfeeding.

The issue of breastfeeding is a crucial one for pregnant women living with HIV. In many developing nations they have a tough choice: either breastfeed their babies and risk transmitting the virus through their milk, or give them formula. The latter deprives infants of the natural immunity passed on through breast milk which helps protect against diarrhoea, malnutrition and other potentially deadly diseases. Sanitation can also be an issue, with a scarcity of clean water with which to mix the formula and, in any case, many may not be able to afford to buy it in the first place.

Preventing mothers from dying and babies becoming infected with HIV is one of the nine priority focus areas for UNAIDS and its Cosponsors under the Joint action for results: UNAIDS outcome framework 2009-2011.

Michel Sidibé, UNAIDS Executive Director, has championed this priority and said during a recent visit to Lesotho in Southern Africa, “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.”

The findings from the Kesho Bora study will now be considered by WHO experts, along with other recent data, and the 2006 WHO recommendations on the use of ARVs in pregnant women and on infant feeding and the prevention of mother-to-child transmission will be reviewed in the context of this new evidence. Updated guidelines are expected to be published before the end of the year.

It is clear that this research increases the range of treatment options available to mothers living with the virus and offers them hope that, if they so wish, they have a greater chance of breastfeeding their babies without passing on HIV.

Additional funds for the Kesho Bora study were provided by the European and Developing Countries Clinical Trials Partnership, the Thrasher Foundation, the UK Department for International Development, UNICEF and the Belgian Government.