18 month old baby in Baragwanath Hospital, Soweto, South Africa
Credit: UNAIDS/L. Gubb

Bacille Calmette-Guérin, or BCG, is one of the most widely given vaccines globally and is safe in people with healthy immune systems. WHO recently published further research on the finding that this standard tuberculosis vaccine has a higher risk of causing death in babies living with HIV.

Given the severity of these risks, WHO recommends not vaccinating babies with HIV and delaying vaccination for those whose HIV status is unknown but who have signs or symptoms consistent with HIV infection.

This recommendation came in 2007 and poses several challenges to weak health systems around the world.

It underscores the need for more widespread testing of HIV in babies and pregnant mothers. Clinical symptoms of HIV infection typically occur after 3 months of age but in some countries babies are routinely vaccinated with BCG at birth.

UNAIDS calls for scaling up access to and use of quality services for the prevention of mother-to-child transmission as well as integrated delivery of services for HIV and tuberculosis.

“A selective BCG vaccination policy in HIV-exposed infants will require high uptake of maternal HIV testing, strengthened prevention of mother-to-child transmission services, and better integration of TB and HIV programmes,” said Dr Catherine Hankins, UNAIDS Chief Scientific Adviser in HIV this Week scientific blog.

The results of a three-year study in South Africa were published in the July edition of the journal Bulletin of the WHO. They confirm earlier research which led WHO in 2007 to change BCG vaccination policy for babies. The WHO Global Advisory Committee on Vaccine Safety and the Strategic Advisory Group of Experts TB and HIV experts then published Revised BCG vaccination guidelines for infants at risk for HIV infection.

“This paper gives better information on the risk of generalized BCG infection in HIV infected children and strongly reinforces the need to find better ways to prevent TB in infants (who are most at risk of dying from TB) and for diagnosing HIV in infants,” said Dr Alasdair Reid, UNAIDS TB Adviser.

Recently published op-ed by UNAIDS Executive Director Michel Sidibé

When African leaders discuss economic growth in Africa at this week’s African Union Summit, their options will be constrained by the growing AIDS epidemic and slow progress on reaching the Millennium Development Goals (MDG). For example, over the years we have seen agriculture output being impacted by people unable to till their fields or having to sell their land to take care of themselves and their families. 

But it can be different. At the beginning of this year I visited Khayelitsha, a township in South Africa where I met Thobani, who was cured of TB and has access to AIDS treatment. Now he is able to take care of his son and contribute to his community.  There are nearly 4 million people like Thobani, people who are vital to economic growth in Africa and elsewhere, thanks to organizations such as the Global Fund and the United States President’s PEPFAR initiative, which support 3,000 new patients to start AIDS treatment every day..

There are 22 million people living with HIV in Africa. For every two people who start on antiretroviral treatment, five are newly infected with HIV. This means the number of people in need of treatment will always increase.

Therefore we need to break the trajectory of the epidemic by stopping new HIV infections. This means focusing on prevention.

We also need to make treatment more affordable and ensure sustainable access to quality medicines in Africa. The demand is high, as nearly 80% of the 4 million people on treatment globally live in Africa, but 80% of the drugs distributed in Africa come from abroad.  The waiting line for AIDS treatment is growing exponentially.  Add to this the other top killers in Africa like TB and malaria and the treatment bill is unsustainable.

The drugs are expensive, and they do not work for ever.  Patients will, after a period of time, need to move from first-line treatment for AIDS which today costs $92 per patient per year (well out of reach of people living on two dollars a day) to second-line treatment which costs more than $1,000 for the AIDS drugs alone. In Africa, less than 4% of patients are on second-line therapy, which is far below what effective treatment would require.  Again unsustainable.

Africans will need these medicines for a long time.  They need many others, as well.  Most of these drugs, however, are not produced in Africa for lack of stringent quality standards and manufacturing capacity. Demand for AIDS treatment should become an opportunity for Africa to reform its pharmaceutical practices.  Too often, drugs made in Africa are spurious or low quality.  What Africa needs is a single African Drug Agency, similar to the European Medicines Agency, which regulates the pharmaceutical sector in Europe.

What will this achieve? First, the quality of medicines will be guaranteed across the continent. The agency should have the power and independence to enforce high quality international standards.  This will help close down the market for spurious drugs. Second, manufacturers will not need to run from country to country to get their products approved. Third, this will integrate the African market to attract private sector investments for manufacture of medicines within Africa just as we have seen in Latin America.  Fourth, it will ensure that there is a level playing field for manufactures to compete and market products within Africa and beyond just as India and China are doing. Fifth, it can be a model for removing bottlenecks, not only for medicines, but for wider development that will contribute to an AIDS+MDG movement in Africa. And all of these efforts must work in the best interests of people in need.

This is a concrete step that African leaders can task the African Union to make. UNAIDS will mobilize the UN system, development partners,  promote south to south cooperation, and engage with the private sector to support the establishment of the regulatory agency. In this economic crisis, African leaders have an opportunity for innovation, just as the G8 leaders have an obligation to fulfil their pledge made at Gleneagles to provide universal access to AIDS treatment by 2010. 

Let AIDS not be an obstacle but let the AIDS response provide an opportunity to transform the continent.

Michel Sidibé
Executive Director, Joint United Nations Programme on HIV/AIDS (UNAIDS)

Leaders and representatives from some 50 African countries, as well as guests from the international community are gathered in Sirte, Libya from 1 – 3 July for the 13th ordinary session of the African Union taking place under the theme “Investing in Agriculture for Economic Growth and Food Security”.

UNAIDS Executive Director, Mr Michel Sidibé also attended the meeting where he held several consultations with African leaders. He talked with them about the need to keep AIDS out of isolation and link HIV to the broader international health and development agenda, as represented by the MDGs, emphasizing that the AIDS response can set the pace to help reach the MDGs targets faster.

During the summit, Mr Sidibé met with the President of the African Union Mr Jean Ping and several African leaders including Presidents of Mali, Senegal, Ghana, Central African Republic, Liberia, Zambia, Zimbabwe as well as foreign ministers from Tanzania, Djibouti, Niger, Congo, Chad, Mozambique, Ethiopia, Uganda, Benin and Angola.

Mr Sidibé also underscored the need to turn off the tap of new HIV infections. He called upon all African governments to commit to their national AIDS strategies to a halving the number of new HIV infections between now and the end of 2015, including a commitment to the goal of virtual elimination of mother-to-child-transmission and to mass social mobilization to confront the sexual practices and social norms that put Africa’s citizens—especially its women and girls—at risk of HIV infection.

The need to make treatment more affordable and ensuring sustainable access to quality medicines in Africa was also underlined by the UNAIDS Executive Director. He argued that demand for AIDS treatment should become an opportunity for Africa to reform its pharmaceutical practices and he proposed the creation of a single African Drug Agency to ensure high standards and progress in drug production.

Established in 2002, the 53-member AU is the successor to the Organization of African Unity and seeks to promote the socio-economic integration of the continent, as well as greater unity between the countries and peoples of Africa.

This story first appeared at www.who.int

Dr Kevin De Cock meets Francina, who is experiencing a number of medical complications, at Katutura State Hospital. WHO and partners are developing Namibia's first national HIV drug resistance assessment and Katutura has been chosen as a pilot site.
Credit: WHO/James Oatway 2009

On his last mission as Director of the WHO HIV/AIDS Department, Dr Kevin De Cock visited the Katutura State Hospital in Windhoek, Namibia, where he praised efforts by national authorities and health-care providers to expand antiretroviral treatment (ART) to those in need. “Here’s a very large public hospital which five or six years ago, undoubtedly, would have been filled with patients with advanced HIV disease,” said Dr De Cock, who travelled to Windhoek earlier this month for the 2009 HIV/AIDS Implementers’ Meeting. “There would have been no empty beds, and we would have seen a lot of extremely wasted patients,” he said.

Thanks to ART scale-up, most of those seeking HIV treatment at the Katutura facility are now managed as outpatients. Further, the majority of HIV-positive in-patients looked well, noted Dr De Cock, as he toured the hospital wards, showing the “benefits of timely access to antiretroviral therapy.”

Namibia has one of the highest HIV prevalence rates in the world, with an estimated 15.3% of the adult population affected. At the end of 2007, some 52,000 people in Namibia were receiving ART, according to the latest available figures.

The ART programme at Katutura Hospital was launched in 2003 at the dawn of the “3 by 5 initiative,” a global effort spearheaded by WHO and partners that sought to put three million people on ART by the year 2005. Though that target was only reached in 2007, “3 by 5” is widely credited with galvanizing the unprecedented expansion of ART in low-and middle-income countries.

About 5000 HIV-positive adults and 1100 children are now receiving ART on a regular basis at the clinic. An additional 80 to 120 patients are newly enrolled each month. Many patients learn their HIV status at free HIV testing sites in the Katutura vicinity.
Credit: WHO/James Oatway 2009

“When we first started in 2003, there were no doctors who were trained in ART management,” said Dr Refanus Kooper, a Namibian physician who heads the hospital’s ART clinic. “We began training doctors using WHO guidelines, then standardizing and adapting them to our country settings.”

About 5000 HIV-positive adults and 1100 children are now receiving regular ART at the clinic, and an additional 80 to 120 patients are newly enrolled each month. Many patients learn their HIV status at free HIV testing sites in the Katutura vicinity.

While the majority of patients at Katutura Hospital are responding well to ART, some have experienced adverse reactions. Dr De Cock met one such patient on his visit to the clinic, a 55-year old mother of ten children who was suffering from several medical complications, including extrapulmonary tuberculosis and liver damage. Doctors said the complications were likely attributable to nevirapine, an antiretroviral drug. The patient’s condition illustrates another side of treatment scale-up, said Dr De Cock: “ART is simple, but isn’t always that simple.”

The extent of HIV drug resistance in resource-limited countries has not been systematically assessed. Together with national health authorities and partners, WHO is developing Namibia's first HIV drug resistance assessment, based on the WHO 2008 global strategy. Katutura Hospital has been chosen as a pilot site for this initiative.

For information and tools on the AIDS response in French as well as community fora, web users will find much of interest on VIH.org

For information and tools on the AIDS response in French as well as community fora, web users will find much of interest on vih.org.

This information portal offers a wide range of tools and services in French to community service professionals working in the field of HIV around the world including doctors, researchers, institutions and non-governmental organizations and people living in countries.

The site builds on the analysis and exchange work conducted over the past ten years by the French Pistes Association via its papers “Transcriptases” and “Swaps.” It is led by a team of journalists and experts in HIV and in close association with the CRIPS Ile-de-France, a French regional information centre for public health advice, especially for young people in areas of sexual health, drug use and HIV prevention.

vih.org offers a place to exchange information via participative community fora which visitors can contribute to or even create new discussions on a range of issues. Discussions currently taking place online include “the exclusion of gay men from blood donation services in France” and “is exclusive breastfeeding feasible in Africa.”

In this way the vih.org web site enables users to build relationships with people sharing similar concerns or interests. The user is also able to customize site content according to their interest or location in order to easily access the information they need.

The involvement and contributions of people and institutions based in low and middle income countries is central to the web portal. Participation is seen as central to contribute to disease management, the facilitation of research and information sharing, promotion of work and dissemination of information.

The vih.org portal is supported by Crips Île-de-France; the French Ministry of Health; the French Ministry of Foreign Affairs, the French national agency on HIV and viral hepatitis research - ANRS; GlaxoSmithKline; Bristol-Myers Squibb; Abbott Laboratories; Boehringer Ingelheim; Roche; Gilead; Tibotec and Esther.

Thirty young leaders from around the world came together in Oslo June 23 - 25 for the

aids2031, in collaboration with the Norwegian Ministry of Foreign Affairs and UNAIDS Goodwill Ambassador Her Royal Highness Crown Princess Mette-Marit of Norway, hosted the Summit to promote and galvanize young leadership in the fight against AIDS-related stigma and discrimination.

L to R: Heidi Larson, Executive Director aids2031, UNAIDS Executive Director Michel Sidibé, UNAIDS Goodwill Ambassador Her Royal Highness Crown Princess Mette-Marit of Norway. Credit: aids2031

"We are here to talk about the future- but more importantly we are here to make the future" said HRH Princess Mette-Marit in her opening remarks welcoming the young participants.

UNAIDS Executive Director Michel Sidibé addressed the forum as an Advisor Participant. “I believe that young people are the future, and offer my to support young leaders because they are a force for change in the future,” said Mr Sidibé.

UNAIDS has made empowering young people one of its priority areas as noted in Outcome Framework: Joint Action for Results

Thirty young leaders from around the world came together in Oslo June 23 - 25 for the 2009 aids2031 Young Leaders Summit. Credit: aids2031

UNAIDS calls for “putting young people’s leadership at the centre of national responses, providing rights-based sexual and reproductive health education and services and empowering young people to prevent sexual and other transmission of HIV infection among their peers.”

Before and during the three day Summit, over 30 young leaders from around the world worked together to identify pressing stigma and discrimination issues for young people and identify ways to leverage current strategies and collaborations. The event was designed by a youth-led planning committee and followed the first aids2031 Young Leader’s summit held at the Google Headquarters in California in 2008.

Young leaders reviewed the recommendations of aids2031's researchers, scientists, and practitioners for building a long-term response to AIDS. On the closing day of the Summit, they shared their recommendations on how to address youth AIDS issues for the aids2031 report, “An Agenda for the Future.”

They hope their recommendations for policy-makers, international institutions, the media, funders and other young people are considered, and called for their collective implementation.

Credit: UNAIDS 

UNAIDS welcomes four Youth Fellows who arrived this month in Geneva for the second round of the UNAIDS Special Youth Programme.

Remmy Malawa Shawa, Esther Ekechukwu, Rumbidzayi Masiyiwa and Tim Scully were among almost 1800 candidates who applied for this year’s programme. They will be with UNAIDS Geneva for 5 months and after their induction and an initial research assignment they will each be assigned to a specific team within the UNAIDS Secretariat. Subsequently they will continue their fellowship in the UNAIDS office of their country or region of origin for a further four months.

The objectives of the programme are:

1. To create opportunities at appropriate levels of the organization to engage youth in policy development and programming;
2. To help build the capacity of young people and strengthen their leadership skills to contribute to the AIDS response, especially at the country level;
3. To sensitize both the young people and UNAIDS staff on various modalities of working together to address issues related to HIV, particularly youth concerns, gender, GIPA and human rights.

Tim is from Malaysia and has experience as a Youth Outreach Manager, coordinating events and meetings for the MSM programmes at the Pink Triangle Foundation in Malaysia. He will be working with the Civil Society and Partnerships team.

Esther comes from Nigeria and has a Masters in Public Health from the University of Ibadan. She is a core volunteer for the Global Youth’s Action project for ActionAid in Nigeria and will be working with the Advocacy Team.

Rumbidzayi is from Zimbabwe and holds a BA in Social Science and Psychology. She has worked in Harare with the Community Working Group on Health as an intern within their Youth and Reproductive Health Programme. Rumbidzayi will be working with the Prevention Team.

Remmy is from Zambia and has just completed his studies at the University of Zambia, conducting academic research in Gender and Health. He has worked as a focal point in his home country for the Global Youth Coalition on AIDS (GYCA) and will be working with the Gender Team.

More than 250 people from business and NGO sectors, government and multilateral bodies are gathering in Washington, D.C. for the annual conference of the Global Business Coalition on HIV/AIDS, Tuberculosis, and Malaria. The Coalition, know as GBC, has convened the two-day event to help ensure that private sector initiatives on these three diseases remains high on the corporate agenda.

The GBC brings the private sector's solutions-oriented approach and drive for measurable results to addressing HIV, tuberculosis and malaria. Members will discuss how to deliver practical tools and strategies that result in programmes achieving greater impact while being more cost-effective. Sessions are designed for exchanging knowledge and a diversity of perspectives, and also for investigating how to turn these reflections and ideas into action and results.

Participants from partner organizations and businesses include Clarence Cazalot, Marathon Oil CEO and Sir Mark Moody-Stuart, Chairman of Anglo American plc; who will join participants from global health and development including Philippe Douste-Blazy, Under-Secretary-General In Charge of Innovative Financing for Development United Nations; Gayle Smith, Special Assistant to U.S. President Obama; Mark Dybul, Former U.S. Global AIDS Coordinator and Co-director; Stefan Emblad, Director of Resource Mobilization Unit of the Global Fund to Fight AIDS, Tuberculosis, and Malaria; Hannah Kettler, Senior Program Officer and Economist, the Bill & Melinda Gates Foundation; British Robinson, Director of Public-Private Partnerships of PEPFAR; and Ambassador Karl Hoffman, President & CEO of Population Services International (PSI).

Regina Castillo, UNAIDS Head of Private Sector Partnerships will speak at a session on Collective Action where she will share UNAIDS’ perspective on facilitating next generation public-private partnership and the Programme’s experience in developing approaches that yield results for universal access to HIV prevention, treatment, care and support.

The conference will end with the GBC's annual awards for business excellence which recognizes successful business action in the AIDS, TB and malaria responses. The awards dinner will take place on 24 June and be presented by Fareed Zakaria, Newsweek International and CNN Foreign Affairs Journalist.

For more information, please visit website

UNAIDS Programme Coordinating Board, Geneva 22 June 2009
Credit: UNAIDS/P.Virot

UNAIDS Governing body, the Programme Coordinating Board (PCB), is holding its 24th meeting in Geneva from 22-24 June 2009 where Mr Michel Sidibé, addressing the board for the first time as UNAIDS Executive Director, will present progress made and his vision for future action.

The focus of thematic session of this PCB meeting is addressing the HIV-related needs of “people on the move”, as decided by the Board in its 22nd meeting in April 2008. The Board noted that improving HIV information and services for these people will enhance the development, promotion and implementation of national, regional and international strategies and will have a significant impact on human rights, including gender.

Meeting the needs of people on the move for HIV prevention, treatment, care and support is essential for achieving universal access. Global movement patterns are particularly complex, involving forced displacement as well as migration. UNHCR figures indicate that there were 16 million refugees, 26 million internally displaced persons due to conflict and an additional 25 million displaced due to natural disasters in 2007, while the International Organization for Migration (IOM) estimates there were over 200 million international migrants in 2008. Most countries are simultaneously, to varying extents, countries of origin, transit and destination. Some countries also have large numbers of mobile people within their borders. It is estimated that there are at least 100-150 million internal migrants in China alone.

UNAIDS Programme Coordinating Board, Geneva 22 June 2009
Credit: UNAIDS/P.Virot

Mobile populations are sometimes blamed for the spread of HIV, or for increasing the burden on limited services for people living with HIV. In reality, many of the underlying factors driving mobility also increase the vulnerability of mobile populations to HIV infection. Furthermore, migrants, displaced people and other mobile populations living with HIV and those taking antiretroviral medication face additional challenges in obtaining needed care and treatment, which must be addressed. The theme provides wide scope for selecting and discussing issues that often fall between the cracks in national AIDS strategies and in international discussion of forced displacement, internal and international migration and travel.

These include:

1. Humanitarian questions of providing displaced and mobile populations security from conflict and violence, including sexual and gender-based violence;
2. Employment and other economic issues that motivate mobility and link with connections between HIV, economic survival strategies and the vulnerability of children and young people; potential increases in unsafe, concurrent and commercial sexual contacts;
3. Human rights issues in connection with social integration and access to services, and especially in connection with stigma and discrimination against persons living with HIV;
4. Immigration and government legislation which dictates the legal status of people on the move, and thus their access to health services; and
5. Language barriers to use of health and social services, and health care system concerns, notably with regard to access and continuity of HIV treatment, including for opportunistic infections.

Reducing the vulnerability of migrants and mobile populations to HIV, and reducing the impact of HIV on mobile populations, their families and their homes, transit and host communities, requires intergovernmental cooperation (whether between countries or between ministries within a country). It requires the collaboration of the business sector, labour, health and social services, and vulnerable communities and people living with HIV themselves. Thus the importance of discussing the topic in a Programme Coordinating Board thematic segment that brings member states, civil society and international organizations together.

In order to support a productive discussion in the thematic session of the 24th PCB meeting, UNAIDS developed a background paper on the issue of people on the move —forced displacement and migrant populations. The paper provides basic information on movement of people and discusses the links between mobility and HIV vulnerability, as well as the challenges of ensuring that mobile populations have universal access to HIV prevention, treatment, care and support.

Established in 1994 by a resolution of the UN Economic and Social Council and launched in January 1996, UNAIDS is guided by a Programme Coordinating Board (PCB) with representatives of 22 governments from all geographic regions, the UNAIDS Cosponsors, and five representatives of nongovernmental organizations, including associations of people living with HIV.

Noe Sebisaba and his STOP SIDA NGO are helping to mitigate the impact of HIV in Burundi
Courtesy of UNHCR

Noe Sebisaba knows how to turn an adverse situation into something life-affirming. In 1996 he and his family were forced to flee a Burundi in turmoil and ended up in the Kanembwa refugee camp in Tanzania. While in the camp, in 1998, he discovered that he was living with HIV. His wife, who was also HIV positive, died of an AIDS-related illness. On World AIDS Day 2001, at an event organized by the UN refugee agency UNHCR, Mr Sebisaba decided to openly declare his own HIV status, the first known African refugee to do so. He has never looked back. As he says, “I decided to let HIV know; ‘I’ll control you, you’re not going to control me’…I was tired of silence and I found a new reason to live. To challenge HIV and preach forgiveness and love.”

Although initially rejected by his family and community, the disclosure helped galvanize him to challenge the stigma and discrimination rampant among refugees and the host population in Tanzania. He developed a grassroots, community organization, STOP SIDA (STOP AIDS), to intensify the involvement of refugees and the local community in the AIDS response and to disseminate HIV awareness messages at public events, through individual contacts, visits and peer groups.

Active in a number of camps across western Tanzania, STOP SIDA distributed educational materials and advocated support and care for those infected with and affected by the virus. Using himself as an example, Mr Sebisaba found a unique way to help individuals and communities become agents of change in challenging HIV. And he was able to confront some of the particular vulnerabilities faced by refugees whose lives have been uprooted due to conflict, persecution or violence.

There are myriad factors that can increase the vulnerability to HIV of the many millions of refugees and internally displaced people around the world. They often lose their source of income and may have to resort to high-risk behaviour to satisfy their needs. Health and education services often lapse and sources of information on HIV prevention and treatment provision can be disrupted. Social and sexual norms, networks and institutions can also break down and women can be especially vulnerable as rape is often used as a weapon of war during conflicts. In fact, Mr Sebisaba’s wife was herself raped by soldiers in Burundi during the civil war.

The fact that STOP SIDA was able to have an impact in Tanzania was a testament to Mr Sebisaba and his partners’ will and determination. He showed that refugees are not only passive recipients of aid but have powerful coping mechanisms, resilience and ingenuity. Many refugees and members of the surrounding communities participated in STOP SIDA activities and there was a marked increase in take-up of voluntary counseling and testing.

Burundi’s President Pierre Nkurunziza visits STOP SIDA
Courtesy: Noe Sebisaba

In 2005 Mr Sebisaba was repatriated to Burundi by UNHCR and was able to continue his work. In the last seven years the agency has helped nearly 500,000 Burundians return home and supports their continued access to treatment and HIV prevention programmes.

Since 2006, STOP SIDA-NKEBURE UWUMVA has operated in the country, especially in areas with a large number of returnees. Supported by UNHCR and other partners, with offices in the capital Bujumbura and the eastern Cankuzo province, the NGO continues to spread the message of prevention, behaviour change, tolerance and the need for voluntary counseling and testing. Outreach has been especially important in rural areas where AIDS information and anti-stigma messaging find it difficult to penetrate.

In addition, STOP SIDA has become an implementing partner of UNHCR in three camps for Congolese refugees in Burundi where staff use their expertise and experience to help mitigate the impact of the epidemic, including ensuring that clients can receive drug treatment from local hospitals.

Some 450,000 people, both former refugees and those who stayed behind, are being reached by STOP SIDA activities in the eastern provinces of Cankuzo and Ruyigi. In the Congolese camps and surrounding communities some 25,000 are benefiting from the NGO’s initiatives.

UNHCR, the lead UN agency for challenging HIV among refugees and internally displaced people, has co-produced a video about the organization called Love in the time of AIDS, which will be featured during the UNAIDS Programme Coordinating Board thematic session on forced displacement at the Board’s 24th meeting on June 22 to 24. STOP SIDA is highlighted as a best practice of community leadership and mobilization.

What gives Mr Sebisaba the most satisfaction is the feeling that he and his fellow activists have been able to help people accept a positive HIV diagnosis with a degree of hope and optimism and have encouraged people to talk about the epidemic.

“With my decision to say openly that I’m living with HIV, I’ve done my part to try to change the face of the virus. I think I’ve shown that it’s not an automatic death sentence and that you can still lead a rich life. Where I’ve worked, people have been more able to talk openly about having HIV and more people are getting tested. I never have a moment’s regret about disclosing my status. I think it’s really making a difference.”