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.”

Credit: UNAIDS

Ahead of the 24th meeting of the Programme Coordinating Board (PCB) which opens on 22 June 2009, the Joint United Nations Programme on HIV/AIDS has published the UNAIDS Governance Handbook.

The Handbook is collection of key documents pertaining to the governance of UNAIDS including the founding ECOSOC resolutions, Memoranda of Understanding between the Secretariat and Cosponsoring organizations, and key Political Declarations related to HIV.

It is intended as a portable reference tool for a wide audience including member states, Cosponsors, PCB non-governmental organizations as well as UNAIDS staff members.

The Handbook includes descriptions of bodies such as the Committee of Cosponsoring Organizations with guiding principles for UNAIDS Cosponsors. It also details non-governmental civil society participation in Programme Coordinating Board. Under Frequently Asked Questions, it explains the membership and composition of the PCB and its decision making process among other things.

“The Handbook will prove to be an invaluable reference tool for a wide audience in and around our Board meeting as it gathers together key documents on the governance of UNAIDS in one portable booklet,” said Helen Frary, UNAIDS Chief Board and UN Relations.

UNAIDS was established through the Economic and Social Council (ECOSOC) resolution 1994/24 of 26 July 1994 to “undertake a joint and co-sponsored United Nations programme on HIV/AIDS, on the basis of co-ownership, collaborative planning and execution, and an equitable sharing of responsibility” with six UN-system cosponsoring organizations: UNDP, UNICEF, UNFPA, WHO, UNESCO and the World Bank. This group was joined by UNODC in 1999, ILO in 2001, WFP in 2003 and UNHCR in 2003.

The 24th meeting of the PCB will run in Geneva until 24 June.

In response to the urgent need to accelerate the discovery and development of new drugs to fight tuberculosis (TB), a landmark collaboration between the Global Alliance for TB Drug Development (TB Alliance), a non-profit, product development partnership, and Tibotec Inc., (Tibotec), a global pharmaceutical company, was announced at the Pacific Health Summit. 

The two organizations have agreed to share their expertise and resources in the development of “TMC207”, an anti-tuberculosis drug with a new mechanism of action.

Welcoming the news of the collaboration, Dr Alasdair Reid HIV/TB advisor to UNAIDS said, “If the encouraging results of early studies are confirmed, TMC207 will represent the first new class of TB drugs we have had in 40 years, offering hope to people living with HIV who are at increased risk of developing TB disease and especially drug-resistant TB.”

“The rise of multidrug resistant TB and the lack of new drugs to date are among the biggest threats to TB control and the HIV response,” Dr Reid noted.

The interim data from an ongoing Phase II study of TMC207 were recently published in the New England Journal of Medicine. In the placebo-controlled study of 47 patients with multidrug-resistant TB (MDR-TB), it was found that 48% of patients receiving TMC207 in combination with standard treatment converted to negative sputum culture after eight weeks compared with 9% of those who received placebo and standard treatment.

People living with HIV are susceptible to developing TB and are also particularly vulnerable to MDR-TB which has a higher mortality rate, and is significantly more difficult and costly to treat. In 2008–2009, the highest number yet of MDR-TB cases were reported to WHO, with an estimated half a million new MDR-TB cases emerging annually. Simpler and more effective ways to prevent, diagnose and treat TB in people living with HIV are urgently needed.

The TB Alliance aims to accelerate the discovery and development of new TB drugs that will shorten treatment, be effective against resistant strains, and be compatible with antiretroviral therapies for people living with HIV who have TB.

Integrated HIV and TB services

In Joint Action for Results: UNAIDS Outcome Framework 2009-2011, the UNAIDS Secretariat and Cosponsors recommend effective integrated delivery of services for HIV and tuberculosis in order to prevent people living with HIV from dying of tuberculosis.

UNAIDS Executive Director Michel Sidibé is committed to mobilizing leadership in confronting the interlinked epidemics of TB and HIV and to bring the AIDS and TB movements closer together. Earlier this year while participating at the 3rd Stop TB Partners Forum, Mr Sidibé met with TB Programme Managers and TB civil society and stressed that the epidemics of TB and HIV can no longer be addressed in isolation. “We need to ensure that people living with HIV do not die of TB,” Mr Sidibé said.

TB is among the leading causes of death among people living with HIV, and accounts for an estimated 23% of AIDS deaths worldwide.

As the HIV response represents one of the soundest of all possible global investments, it is critical that commitment to HIV efforts be maintained and strengthened in the midst of these economic challenges - Report of the Secretary-General to the 63rd General Assembly.

Dr Aaron Motsoaledi, Minister of Health of South Africa addressed the General Assembly on 16 June 2009
Credit: UN Photo/Jenny Rockett

At the 63rd session of the General Assembly held in New York on 16 June 2009, the United Nations Secretary-General Ban Ki-moon presented a report on the progress made in the implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS. The first address by UN member states was delivered by Dr Aaron Motsoaledi, the new Minister of Health of South Africa. Speaking on behalf of the Southern African Development Community (SADC), Motsoaledi noted recent progress made in South Africa and in the SADC region in confronting AIDS.

This year’s report provides an update on developments in the AIDS response, looks forward to the agreed 2010 milestones, recommends key actions to accelerate progress and urges renewed commitment to the goal of universal access to HIV prevention, treatment, care and support.

In June 2008, the General Assembly held a High-level Meeting on HIV/AIDS that assessed progress in the response to the global HIV epidemic. Reports from 147 countries showed that important progress had been made, including in the areas of access to antiretroviral therapy and the prevention of mother-to-child transmission.

However, the report shows that, despite such encouraging developments, considerable challenges remain, including significant access gaps for key HIV-related services. The pace of new infections continues to outstrip the expansion of treatment programmes, and commitment to HIV prevention remains inadequate. While funds available for HIV in low- and middle-income countries increased from $11.3 billion in 2007 to $13.7 billion in 2008, there has been a global economic downturn since the 2008 High-level Meeting.

As the HIV response represents one of the soundest of all possible global investments, it is critical that commitment to HIV efforts be maintained and strengthened in the midst of these economic challenges, report of the Secretary-General.

The Secretary-General’s report also highlights that despite the many commitments made by Member States to protect the rights of people living with HIV and people vulnerable to HIV infection, many countries have laws and policies that are inconsistent with the commitments and result in reduced access to essential HIV services and commodities.

In 2007, one third of countries reported that they still lacked laws to prohibit HIV-related discrimination, and many countries with anti-discrimination legislation have problems with adequate enforcement. A total of 84 countries reported that they have laws and regulations that present obstacles to effective HIV prevention, treatment, care and support for vulnerable subpopulations. Furthermore, some 60 countries have laws that restrict the entry, stay and residence of people living with HIV based on HIV-positive status only. Finally, an increasing number of countries have enacted overly broad laws that criminalize transmission or exposure to HIV, as well as non-disclosure of HIV status. Such measures are likely to lead people to avoid HIV testing, thereby undermining efforts to achieve universal access. Therefore, the report recommends that laws and law enforcement should be improved and programmes to support access to justice should be taken to scale to prevent discrimination against people living with HIV. HIV-related travel restrictions should be eliminated; the criminalization of HIV transmission should be limited to intentional transmission; and laws that burden or impede service access among sex workers, men who have sex with men and injecting drug users should be repealed.

Improved analytic methods have enabled countries to better characterize the magnitude and dynamics of their epidemics, to select appropriate interventions and tailor evidence-informed strategies to address their specific national context. The strategic tailoring of national responses magnifies the results of HIV programmes and reduces waste and inefficiency. Improved monitoring and evaluation systems also permit countries to revise national strategies as their epidemics evolve over time. In their efforts to closely align national strategies with actual national circumstances, countries should work to understand and address the social and structural determinants of HIV risk and vulnerability, such as gender inequalities, social marginalization and stigma and discrimination.

The HIV epidemic presents a long-term global challenge and requires a sustained commitment for an effective long-term response. As the coverage and quality of HIV programmes increase, the report calls to intensify efforts to strengthen the health, education, social welfare and other key sectors, and to integrate HIV with tuberculosis, sexual and reproductive health and other health services.

The long-term AIDS response will be sustainable only if substantially greater success is achieved in slowing the rate of new HIV infections, while providing optimal services for people living with HIV, the report underlines. Bringing to scale the appropriate mix of behavioural, biomedical and structural HIV-prevention strategies would more than halve the number of all new HIV infections between now and 2015. Access to such a combination of prevention strategies, however, remains sharply limited in most countries according to the Secretary-General’s report.

Finally, the report emphasizes that achieving national universal access targets by 2010 will require an estimated annual outlay of $25 billion within two years, necessitating renewed commitment from all providers of HIV-related funding. Sustaining an effective AIDS response will require unprecedented leadership at all levels, including from Governments, civil society and affected communities.