Credit: UNAIDS

Top United Nations officials today urged countries to maintain and strengthen their commitments to tackle HIV and AIDS in the midst of the global economic downturn, warning that slashing resources now could mean greater costs and suffering in the future.

Addressing a meeting of the General Assembly convened to assess progress in the response to the global epidemic, its President, Miguel D’Escoto, noted that people living with HIV/AIDS have been placed at greater risk as a result of the global financial and economic crisis that is crippling economies around the world.

“As a result of this ongoing crisis, I fear that many governments are resigned to reducing programmes and diminished expectations,” he told delegates. “But it is precisely when times are difficult that our true values and the sincerity of our commitment are most clearly evident.

“Even as we see signs of cutbacks in AIDS funding in many countries, we must remind governments and the international community that the world has the resources to mount the kind of AIDS response to which we have committed.

“If we allow cuts now, we will face increased costs and great human suffering in the future,” he stated.

In 2006, the Assembly pledged to achieve universal access to comprehensive HIV prevention, treatment, care and support by 2010. A report by Secretary-General Ban Ki-moon on progress on HIV/AIDS commitments shows that achieving national universal access targets by 2010 will require an estimated annual outlay of $25 billion within two years.

Mr. D’Escoto said that, as the Joint UN Programme on HIV/AIDS (UNAIDS) has pointed out, the amounts needed to achieve this goal represent “a miniscule fraction” of the sums that have been spent this year on economic stimulus measures.

The Secretary-General’s report also highlights a number of encouraging developments such as countries establishing clear national targets for universal access, and a continued increase in financing for HIV programmes in low- and middle-income countries, reaching $13.7 billion in 2008.

At the same time, the report says considerable challenges remain, including significant access gaps for key HIV-related services. Also, the pace of new infections continues to outstrip the expansion of treatment programmes, and commitment to HIV prevention remains inadequate.

“Now is not the time to falter,” Secretary-General Ban Ki-moon told the meeting. “The economic crisis should not be an excuse to abandon commitments – it should be an impetus to make the right investments that will yield benefits for generations to come.”

Mr. Ban said that a vigorous and effective response to the AIDS epidemic is integrally linked to meeting global commitments to reduce poverty, prevent hunger, lower childhood mortality, and protect the health and well being of women.

“But to achieve the goal of universal access, barriers to progress need to be overcome. Not just in battling the disease, but also in confronting obstacles that society puts in the way,” he said, adding that the fight against AIDS also requires attacking “diseases of the human spirit – prejudice, discrimination, stigma.”

He called on all governments to review their legal frameworks to ensure compliance with the human rights principles on which a sound AIDS response is based. “This is not solely a medical or scientific challenge. It is a moral challenge, too,” he said.

Speaking to reporters after addressing the meeting, the Secretary-General discussed his own efforts to attack prejudice, discrimination and stigma. Among them, he said he met regularly with UN staff who lived with HIV and that he is pushing for all people living with HIV to participate in society without fear of discrimination.

He was joined by UNAIDS chief Michel Sidibé, who commended Mr. Ban’s leadership in helping to break the “conspiracy of silence” on stigma, discrimination and criminalization against people living with HIV, particularly among vulnerable groups – homosexuals, sex workers and drug users.

He added that “time is running out,” noting that the 2010 deadline for achieving universal access is right around the corner. “Unfortunately, we are far from reaching our goals.”

Some 84 countries have reported that they have laws and policies that act as obstacles to effective HIV prevention, treatment, care and support for vulnerable populations, according to UNAIDS.

“Achieving universal access to prevention, treatment, care and support is a human rights imperative. It is essential that the global response to the AIDS epidemic is grounded in human rights and that discrimination and punitive laws against those most affected by HIV are removed,” stated Mr. Sidibé.

The 2009 report of the Global Campaign of the Health MDGs: Leading by Example - Protecting the most vulnerable during the economic crisis.

The United Nations Secretary-General Ban Ki-moon and the Foreign Minister of Norway Jonas Gahr Støre launched the 2009 report of the Global Campaign of the Health MDGs, Leading by Example - Protecting the most vulnerable during the economic crisis. The launch coincided with the High-Level Forum on Advancing Global Health in the Face of Crisis which was held on 15 June at United Nations Headquarters, New York.

The report highlights that recent actions from governments, international agencies and civil society have started to show positive impact on the health of mothers and children. This has given hope for accelerating progress towards the Millennium Development Goals (MDGs) 4 & 5 —aiming to reduce child mortality by two-thirds and maternal mortality by three-quarters by 2015. However, this progress is now threatened by the most severe global economic crisis since the 1930s, especially in low-income countries.

According to the report, more money is needed to accelerate the progress towards the health goals and more specifically to save millions of mothers and their newborn babies.

The Network of Global Leaders, which includes twelve leaders from developing and donor countries, contributed to the report and they urged leaders to take measure to protect the vulnerable, especially women and children, from the economic downturn. "The global economic crisis demonstrates how inter-dependent we have become as a global community. This is the time to honour our commitments and invest in our common future," say the leaders in their signed overview of the report.

The Global Campaign for the Health MDGs was launched by Prime Minister Stoltenberg with other global leaders in New York in September 2007. The aim of the campaign is to increase and sustain the political and financial commitment for the health MDGs, in particular those protecting the most vulnerable, women and children.

The Network of Global Leaders is a group of international leaders that provide political backing and advocacy at the highest possible level for the Global Campaign for the Health MDGs.

According to A Strategic Approach: HIV & AIDS and Education, this sector can play a central part in the response to HIV by “doing more of what it is doing already and doing it better.”
Credit: UNESCO

Education can play a critical role in the global challenge to HIV simply by “doing more of what it is doing already and doing it better,” and ensuring that all children have access to good quality learning. This is a key conclusion emerging from a new publication by the UNAIDS Inter-Agency Task Team (IATT) on Education which explores what is already known and what needs to be learned about expanding the education sector’s response to the epidemic.

A Strategic Approach: HIV & AIDS and Education is being launched this week at the IATT Symposium taking place in Limerick, Ireland, by Peter Power T.D., Minister of State for Overseas Development. It examines how education can help mitigate the effects of HIV and how this key sector should be an integral part of any national AIDS programme. The report, an extensive update on a previous 2003 publication, highlights the fact that education in itself provides protection against the virus and that more and better schooling should therefore be the first line of the response. A second and complementary measure is the introduction of specific actions tailored to the epidemic, such as the provision of HIV and sexuality education.

Credit: UNESCO

Michel Sidibé, UNAIDS Executive Director, states in the publication’s foreword that “Education is empowering. It facilitates the acquisition and use of knowledge, competencies, attitudes and behaviours that are essential for healthy lifestyles….it enhances public accountability, promotes inter-generational dialogue and leads to better use of available services, especially health and social protection.” He adds: “education can address the social, cultural and economic conditions that contribute to increased vulnerability...”

Aimed at decision-makers and practitioners in the field of education and their partners working on the AIDS response in other sectors, A Strategic Approach: HIV & AIDS and Education identifies key priorities.

There is an emphasis on ‘knowing your epidemic’ so that each response is tailor-made to fit the local epidemiological reality. It also argues for two central objectives: first, the prevention of HIV (including the reduction of both social vulnerability and individual risk-taking) and, second, the mitigation of the impact of AIDS.

The report also contends that young people should be given access to the full range of information and resources so that they can protect themselves effectively. This requires that curriculum and learning materials be available in clear and understandable language and that HIV and sexuality education be delivered in an age-appropriate and culturally sensitive manner. Education should “comprehensively cover” such issues as relationships, sexual networks (including same-sex relations) and drug use. However, the publication also points to a recent study among young people in Africa by the Guttmacher Institute which shows that although most teenagers think sex education should be taught in schools, less than half of them receive it.

Credit: UNESCO

A Strategic Approach: HIV & AIDS and Education is primarily focused on school-based learning but it recognises that many of the young people most at risk have often never been to school or have dropped out. This demonstrates the importance not only of reaching out-of-school young people but of enlarging the provision of education, making sure more girls attend school and that greater numbers of children make the transition from primary to secondary institutions.

Empowering young people to protect themselves from HIV is one of the eight priority focus areas for UNAIDS and its Cosponsors under the Joint action for results: UNAIDS outcome framework 2009-2011. Through A Strategic Approach: HIV & AIDS and Education, the UNAIDS Inter-Agency Task Team hopes that this central aim can be brought a step closer to being realised.

Formed in 2002, the IATT on Education is convened by UNESCO and brings together UNAIDS Cosponsors, bilateral agencies, private donors and civil society partners with the purpose of accelerating and improving a coordinated and harmonised education sector response to HIV.

Copies of A Strategic Approach: HIV & AIDS and Education can be requested free of charge from info-iatt@unesco.org  Please specify quantity, language version(s), and mailing address. If you are requesting more than 5 copies, please state intended use.

This year’s Implementers Meeting was marked by a sense that the global response to AIDS has moved into a new phase – a time when it is necessary to take thoughtful stock of what has been achieved over the last few years.

The 2009 HIV/AIDS Implementers’ Meeting opened on June 10 in Namibia, drawing more than 1,500 participants from more than 55 countries around the world to Windhoek. With the theme : “Optimizing the Response: Partnerships for Sustainability”, this year’s meeting focused on optimizing the impact of prevention, treatment and care programmes, enhancing programme quality, promoting coordination among partners and encouraging innovative responses to the AIDS pandemic.

“This meeting represents a renewed call to all partners to continue working together to fight the AIDS pandemic,” said H.E. Hifikepunye Phamba, President of the Republic of Namibia who opened the meeting. “It serves as another important platform to showcase the successes that have been achieved over the years. This in turn should motivate everyone to persevere in the noble work that is being done.”

In his opening speech, UNAIDS Deputy Executive Director, a.i., Paul De Lay spoke about the global pledge to move towards universal access to HIV prevention, treatment, care and support and stressed that although a number of countries have taken great strides to reach universal access for antiretroviral treatment and prevention of mother to child transmission, there are many that are struggling to bring services to those who need them. He urged countries to continue spending on AIDS during the current economic downturn: “the life-saving programmes you are putting in place will yield dividends that last for generations,” he said.

The opening ceremony was preceded by a meeting between UNAIDS and United States Government representatives. The meeting discussed the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) Partnership Frameworks between partner governments and other partners that will guide PEPFAR’s response to AIDS in the host countries through service delivery, policy reform, and coordinated financial commitments. The meeting was also a chance for UNAIDS and the US Government to establish a mechanism for regular communication in the future. UNAIDS expressed appreciation toward the US Government’s effort to encourage coordination and synergies at country level and increasing the efficient use of resources.

Kate Thomson, UNAIDS Chief of Civil Society Partnerships spoke about the UNAIDS’ commitment to promoting gender rights and equality and to remove punitive laws, policies and practices as well as the stigma and discrimination that hinder effective responses to HIV. In response, PEPFAR reaffirmed its endorsement of a rights-based approach and its commitment to creating more enabling environments. 

At a press briefing moderated by UNAIDS with the participation of key representatives from the Implementers Meeting co-sponsors, journalists and reporters  where introduced to universal access to treatment, care and support and were briefed on some of the key strategies and frameworks governing current AIDS work.

During the briefing, key issues surrounding HIV prevention were presented by Helen Jackson, Senior HIV Prevention Advisor with the UNAIDS Regional Support Team for Eastern and Southern Africa. She stressed the importance of prioritising evidence-based interventions and the need to focus on combination prevention, that is, combining a series of behavioural, structural, and biomedical prevention approaches to achieve maximum impact on HIV prevention.

On June 11, one of the sessions moderated by UNAIDS focused on stigma and discrimination and presented a new tool to measure and understand HIV-related stigma called the, ‘People Living with HIV Stigma Index’. The Index is one of a number of tools developed over the last decade to measure and better understand HIV-related stigma. Kate Thomson, UNAIDS Chief of Civil Society Partnerships said that this tool is particularly important because “it can shape future programmatic interventions and policy change.”  “The Index will be a powerful advocacy tool which will support governments, civil society and activists alike to reduce the stigma and discrimination linked to HIV,” she added. 
On the same day, Susan Kasedde, Regional Advisor with the UNAIDS Regional Support Team for Eastern and Southern Africa moderated a satellite session with the title ‘Knowledge Translation and HIV Incidence Measurement’. During this session, countries reported on the results of the “Modes of HIV Transmission” studies  they carried out last year with the support of UNAIDS and the World Bank.

“It was particularly interesting to hear from the country representatives on how the results of the Modes of Transmission studies have impacted on policy and strategy development at the national level and on the overall national discourse around HIV prevention,” said Kasedde.

In Kenya, the studies’ results have helped defined the country’s national HIV prevention strategy while in Lesotho, they have prompted the development of a national behaviour change communication strategy. Uganda has defined a new prevention policy and guidelines and has declared 2010 the ‘year of couple testing’ based on findings from the study that most infections occur in long term, stable relationships which were previously perceived to be low risk.

This year’s Implementers Meeting was marked by a sense that the global response to AIDS has moved into a new phase – a time when it is necessary to take thoughtful stock of what has been achieved over the last few years. The global economic downturn has heightened the need for reflection about what works – and what does not work – and to increase efficiency of programme implementations in all areas of the response to AIDS.

A short report by UNAIDS on AIDS and Global Health examines the role that the health sector should play in helping to attain the goal of universal access to HIV prevention, treatment, care and support. Credit: UNAIDS/P.Virot

The High-Level Forum on Advancing Global Health in the Face of Crisis is taking place at United Nations Headquarters on Monday, 15 June 2009. The Secretary-General is hosting the day long forum in order to elevate the global health debate and engage multisectoral representatives from around the world.

A short report by UNAIDS on AIDS and Global Health made available for this event examines the role that the health sector should play in helping to attain the goal of universal access to HIV prevention, treatment, care and support. Over the past decade the AIDS response has played a major role in producing better health outcomes for people in developing countries and has mobilized a whole range of stakeholders in efforts to build health systems worldwide. However, much work still needs to be done.

The AIDS epidemic is part of the global health landscape, just as the global health agenda is part of the AIDS response. The new report shows that the response to AIDS is an opportunity to improve health systems worldwide. Also discussed is that other areas that contribute to health solutions, such as human rights, the law and education, need to be embraced if we are to maximize outcomes, and that health equity must be addressed.

Shortfall in health resources

Investment in global health has increased significantly in recent years, and investment in the AIDS response has grown from US$ 300 million in 1996 to nearly US$ 14 billion in 2007. However, resources are still falling short for all health needs, and AIDS is no exception. With 7400 new HIV infections each day, the shortfall grows ever greater, and to achieve universal access in 2010 will require US$ 25 billion: US$ 11 billion more than is available today. Advocates for global health must therefore find ways to increase sound investments in health and the AIDS response.

Community services strengthened

It has been shown that there are many beneficial effects from an increase in AIDS resources being spent on health and community systems. A case study described in the report looks at how increased funding for HIV in Nigeria has trickled down to improvements at the local level in a whole range of areas, which in turn helps in the fight against many other diseases. Focusing on a hospital in Jengre, Nigeria, the case study shows that AIDS funding has helped provide free services for children and pregnant mothers enrolled in antenatal care, in addition to enabling major improvements in the hospital’s infrastructure and its ability to tackle the other poverty diseases: tuberculosis and malaria.

Linking AIDS treatment and HIV prevention to other health issues, such as sexual reproductive health, tuberculosis and safe motherhood, has meant that they themselves receive more attention. AIDS responses have also strengthened hospital infection control and improved blood safety and transfusions. The issue of paediatric AIDS has contributed to the debate on better medicines for children, and new opportunities have emerged to challenge those social norms that contribute to ill health.

HIV: health issue and social issue

AIDS and global health notes that HIV is both a health issue and a social issue. By involving the education, agriculture, business, media, labour and other social service sectors, the AIDS response has been able to leverage better health outcomes, just as efforts to eradicate polio and reduce tobacco use have done in recent years. HIV has highlighted the underlying causes of poor health: social determinants such as gender inequality, stigma, migration and lack of education. A lesson learned is that social determinants must be addressed when addressing global health needs.

Sections of the report on tuberculosis and HIV, climate change and HIV and A (H1N1) influenza stress the diverse areas that global health and AIDS cut across.

In conclusion, the report reminds us that much has been accomplished under the emergency conditions of the past 25 years, but that the global response is at a crossroads. The AIDS response and the health response should not work in isolation, but should be united around one common goal: results for people.

The comic book Luis Figo and the World Tuberculosis Cup seeks to teach children and teens about tuberculosis, its relationship with HIV, and how to prevent it.

International football icon and Stop TB Ambassador Luis Figo is the main character of an educational comic book that provides key information on tuberculosis (TB). Luis Figo and the World Tuberculosis Cup was produced by the Stop TB Partnership, an international health partnership whose secretariat is housed by the World Health Organization (WHO) in Geneva, with support from UNAIDS.

The comic book features Figo as the captain of a team of teen-aged girls and boys. Together they win a football match against a squad of tuberculosis germs. The comic book seeks to teach children and teens about tuberculosis, its relationship with HIV, and how to prevent it.

In a statement released on the occasion of the launch Figo urged young people everywhere to take the comic book's messages seriously. "Tuberculosis is a killer, and I want all of you to stay safe from it. I am passing the ball to you -- you can help reach the goal of stopping tuberculosis," he said.

The book is available in Arabic, Chinese, English, French, Khmer, Kiswaili, Hindi, Portuguese, Russian, and Spanish and is being distributed in several countries in collaboration with local partners. An estimated number of 70 000 comic books have been so far distributed through country-based events. The comic book is also available for download at www.stoptb.org/figo

An international competition for comic artists to design the educational book was launched in 2008. A jury of cartoon experts from worldwide organizations together with representatives from UN organizations selected the winning proposal which was presented in Lisbon on 24 July 2008.

HIV and TB are so closely connected that they are often referred to as co-epidemics or dual epidemics.

The comic book has now become an animated cartoon that will be launched in Geneva on 13 June during the All Stars '09, a charity match organized by the Luis Figo Foundation. The animated cartoon version of Luìs Figo and the World Tuberculosis Cup will be shown in its French-language version at the gala match. It will soon also be available in Arabic, English, Portuguese, Russian and Spanish and broadcast widely around the world.

The fundraising game will take place at the Stade de Genève and will also feature current and former soccer stars and trainers including Mourinho, Chistian Chivu, Ronaldinho, Clarence Seedorf, Fabio Capello, Giovanni Trapattoni and Giga Popescu.

Tuberculosis and HIV

TB is the leading causes of death among people living with HIV, and accounts for an estimated 23% of AIDS deaths worldwide. HIV and TB are so closely connected that they are often referred to as co-epidemics or dual epidemics. The epidemics drive and reinforce one another: HIV activates dormant TB in a person, who then becomes infectious and able to spread the TB bacillus to others.

Untreated, someone with active tuberculosis will infect an estimated 10 to 15 people per year. The Stop TB Strategy is the internationally recommended standard for preventing, diagnosing and treating TB and includes recommendations for managing TB in people living with HIV.

Recently a new TB strain, extensively drug resistant TB (XDR TB), has emerged, which is particularly dangerous for people living with HIV in whom it is frequently fatal. Preventing the development and spread of drug resistant TB through greater investment in TB services, improved community case finding and adherence support, and more effective infection control are essential.

UNAIDS, the Stop TB Partnership and the World Health Organization (WHO) are together encouraging a concerted, coordinated global effort to control TB in people living with HIV. In addition, the Stop TB Partnership has formed the TB/HIV Working Group, which develops global policy on the control of HIV-related TB and advises on how those fighting against TB and HIV can work together.

These partnerships have led to the creation of policies and guidelines to deal with HIV-related TB, and countries and organizations have taken important steps towards integrating their HIV and TB responses.

As part of the 2009 HIV/AIDS Implementers meeting being held in Windhoek, Namibia, delegates had the opportunity to visit HIV projects in the area to find out what is being done on the ground to support people living with HIV.

One of the projects was the Bernhard Nordkamp Social Service Centre which offers training and outreach programmes for HIV prevention, care and support, voluntary HIV testing and counselling, post-test support groups and an after school learning programme.

Since it was established by Catholic AIDS Action in 1999, the centre which is Namibia’s first faith-based community HIV outreach and support centre, has registered over 1,500 orphans and vulnerable children. The children receive choir practice, music classes, art therapy, and homework assistance. A computer lab, which helps the children improve their mathematics and English skills through computer aided learning, is also available for use.

“It is impressive to see the dedication of the staff and volunteers,” said Paul De Lay, UNAIDS Executive Director Programme, ad interim. “It is the commitment of organisations like this which is really making a difference to peoples lives at the community level.”

The centre also runs a soup kitchen catering for 130 children each day, primarily children most in need including children living with HIV and orphans.

Some 60 volunteers work for the centre and provide support to nearly 600 families through their home-based family care services. This programme also reaches around 990 orphans who receive psychosocial support. Another of the centre’s activities is to provide income generating projects for people living with HIV. One of the activities, called the “Beaded Red Ribbon” project, is providing income to around 25 families. Other income generating activities include producing greeting cards, jewellery, and Christmas ornaments.

H.E. Hifikepunye Pohamba, President of the Republic of Namibia, addresses attendees at the opening of the 2009 HIV/AIDS Implementers’ Meeting in Windhoek, Namibia on June 10, 2009. Credit: Lukas Amakali.

From June 10-14, more than 1,500 implementers from around the world will gather in Windhoek to share best practices and lessons learned during the implementation of multi-sectoral AIDS programs with a focus on optimizing the impact of prevention, treatment and care programs; enhancing program quality; promoting coordination among partners; and encouraging innovative responses.

The 2009 HIV/AIDS Implementers' Meeting will be hosted by the Government of Namibia, and co-sponsored by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); the Global Fund to Fight AIDS, Tuberculosis and Malaria; UNAIDS; UNICEF; the World Bank; the World Health Organization; and the Global Network of People Living with HIV/AIDS.

“With universal access as the overarching goal of the meeting, I hope that we will pay particular attention to the urgent need to strengthen HIV prevention efforts,” said Paul De Lay, UNAIDS Deputy Executive Director Programme, a.i., who will address participants at the opening of 2009 HIV/AIDS Implementers Meeting.

The conference theme is “Optimizing the Response: Partnerships for Sustainability.” Reflecting this theme, presentations will focus on what program implementers are doing to meet the challenges affecting the scale-up of HIV prevention, treatment and care. The meeting’s six research tracks cut across all subject matter areas of AIDS programming and include:

1. Responding to challenges in HIV prevention;
2. Women and children;
3. Effective HIV prevention, treatment, care and support programmes for men who have sex with men, drug-users, people in prisons, and people in sex work;
4. Evolving challenges in treatment, laboratory, care and support services;
5. Performance-based programming and systems-strengthening; and
6. Cross-cutting issues.

To learn more about the 2009 HIV/AIDS Implementers’ Meeting, please visit www.hivimplementers.org 

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

Vusie Maphalala takes part in a joint project run by WFP and Swaziland’s Ministry of Health.
Credit: WFP/Banele Dlamini

Dressed in his smartest suit, Vusie Maphalala waits patiently in the tiny health clinic in Mpolonjeni, located in Swaziland’s capital Mbabane, to collect his life-saving antiretroviral drugs. As a man with HIV, he knows that they are the key to survival – to living long enough to help his three small children grow up.

But he also knows that drugs alone are not enough.

Two years ago, he watched his wife die. She was on HIV treatment but was too weak and too malnourished to thrive. So Mr Maphalala comes each month not just to pick up his drugs but also his food ration which he receives under a joint project run by WFP and Swaziland’s Ministry of Health. Every month he receives more than seven kilogrammes of nutritious corn-soya blend known locally as ‘sidonono’.

Health started improving

“I was malnourished and virtually bedridden when I started getting food from WFP,” said 44-year-old Mr Maphalala, who had been battling to take the drugs on an empty stomach. “But within two months, my health and strength started improving.”

According to Martin Bloem, Chief of the HIV and Nutrition Service at WFP, “Good nutrition is essential in the treatment of HIV particularly in regions where it coincides with widespread malnutrition and tuberculosis. The current economic crisis makes it even harder for people on treatment to stay well fed."

There is no doubt, in Mr Maphalala’s mind, how important the food rations have been. “This area has often been hit by drought and sometimes there was no food, which made it very difficult to keep on taking my medication,” he said, knowing people who have been too hungry to continue their treatment. “But I don’t miss a single dose any more.”

Support to others

Now Mr Maphalala is healthy enough to do manual work and to look after his sons – as well as providing much-needed support to other HIV-positive people in his community who receive antiretroviral therapy (ART).

“As a volunteer, I help people who have recently enrolled in ART to plan their drug schedule,” he said. “I also teach them the importance of nutrition and explain that eating the corn-soya blend will help them stick to that schedule.”

Swaziland has one of the highest levels of HIV in the world. According to latest WHO/UNAIDS/UNICEF estimates, some 26 percent of the adult population is living with the virus. The 2008 Swaziland Country Progress Report states that prevalence among women is 31 percent. Young girls aged 15-24 are disproportionately affected and are nearly four times more likely to be infected than their male counterparts. The demand for treatment has been rising and in 2007 almost 60,000 people were in need of ART, 42% of whom received it.

Nutrition and food security are key components of treatment, care and support for individuals, families and communities affected by HIV, particularly in sub-Saharan Africa. Poor nutrition can hasten the onset of AIDS-related illnesses as well as making it more difficult to stick to ART. HIV also weakens the immune system and can impair food intake and absorption of nutrients. And in fact, those living with the virus need more food than those not infected. Adults with HIV have an energy requirement 10-30% higher than normal. This figure rises to 50-100% in children.

Addressing nutrition and food security is essential if the overarching international commitment to provide universal access to HIV prevention, treatment, care and support services by 2010 is to be met.

WFP implements AIDS programmes in over 50 countries addressing treatment, care and support and impact mitigation.

The seven Guidance Briefs on young people and HIV help strengthen the response to the epidemic among this key group

In 2007, around 40% of new infections were in the 15-24 age group and more than 5 million youth are living with the virus, around 60% of whom are girls.

Empowering young people to protect themselves from HIV is one of the eight priority focus areas for UNAIDS and its Cosponsors under the Joint action for results: UNAIDS outcome framework 2009-2011.

In order to give young people the urgent attention they need, a series of seven Guidance Briefs has been developed by the UNAIDS Inter-Agency Task Team (IATT) on HIV and Young People.

The Task Team, convened by UNFPA, intends the Briefs to be used to guide staff, governments, donors and civil society on how to develop and implement an effective response to HIV among young people. Their needs, although reflecting those of the general population to a degree, are also very specific. In the foreword to the series Purnima Mane, UNFPA Deputy Executive Director and Michel Sidibé, UNAIDS Executive Director remark that there is still a long way to go in ensuring young people have access to knowledge.

They contend that despite a global commitment to ensure that 95% of youth have HIV-related information, education, services and life skills by 2010, “[A]s of 2007 only 40% of young men and 36% of young women had accurate knowledge about HIV, showing that even basic HIV awareness programmes have had inadequate reach…. It is essential that we sustain efforts being made as well as scale up the response.”

The needs of young people can often be overlooked during policy development as youth tend to lack a voice when it comes to decision-making around interventions designed for them. The briefs argue, based on global evidence, that their engagement in the development of HIV prevention programmes is not only desirable but “critical to programme success”.

Courtesy of UNFPA

The fourth Guidance Brief in the series, for example, which concentrates on community-based interventions, shows exactly how young people can become engaged in HIV prevention and really make a difference. In Ecuador transgendered youth in the Frontiers Prevention Project developed their own programme to mobilize their peers, who belong to a most-at-risk group, to address the epidemic. The Brief reports that they later formed the country’s first transgender non-governmental organization, demanding health services, challenging discrimination and promoting their human rights. Young people in Zambia are also shown to be getting involved, as they deliver care and support to people living with HIV in their communities.

The series includes an overview which highlights four key areas of action that focus on alleviating the effects of the epidemic on young people:

1. Information to acquire knowledge
2. Opportunities to develop life skills
3. Age-appropriate health services
4. The creation of a safe and supportive environment.

These must all be provided simultaneously, through behaviour change communication strategies, if interventions are to be successful.

The remaining Briefs examine most-at-risk young people and youth in a variety of settings; humanitarian emergencies, community based initiatives, in the health sector, the education sector and in the workplace. Again, the centrality and importance of young people in defining their own role in tackling HIV is demonstrated. The final Brief, concentrating on the workplace, reports that the ILO and its partners in Rwanda organized a youth consultation aimed at finding out their concerns and needs and working out a joint response. The young people said that opportunities for decent work and HIV prevention were “two sides of the same coin”. From this November 2007 meeting, the ‘Kigali call to action’ emerged, which includes measures to promote youth employment and challenge HIV.

The series is not designed to provide a one size fits all “blueprint” for every country to follow. The Task Team hopes that the Guidance Briefs, by presenting a raft of evidence-informed interventions, will encourage partners to explore what works for them in trying to ensure an HIV-free future generation - with young people helping to chart the way forward.

The UNAIDS Inter-Agency Task Team (IATT) on HIV and Young People was created in 2001 and is made of the UNAIDS Secretariat, the 10 UNAIDS Cosponsors, youth and civil society groups, research institutions and donors.