UNAIDS Executive Director Mr Michel Sidibé met on Wednesday 20th May with a delegation of the Caribbean community (CARICOM) at the 62nd World Health Assembly to discuss the Caribbean priorities for collaboration with UNAIDS.

Dr Edward Greene, Assistant-Secretary General of the CARICOM Secretariat and Mr Karl Hood, Minister of Health of Grenada and Chair of the Council of Human and Social Development of CARICOM, opened the meeting acknowledging Mr Sidibé’s leadership in accelerating the global response to HIV as well as the vital role played by UNAIDS in setting up and fostering growth of the Pan Caribbean Partnership against HIV (PANCAP).

In October 2008, during CARICOM’s 7th general assembly, participants approved the Caribbean Regional Strategic Framework for 2008-2013 which focuses on actions that will enable countries to achieve universal access to HIV prevention, treatment, care and support by 2010.

Participants at the meeting made a call to UNAIDS to institutionalize and further strengthen the support it provides in the region. They called for UNAIDS to focus country assistance upon fully implementing the agreed regional Strategic Framework.

In response, Mr Sidibé reaffirmed UNAIDS’ commitment to provide its experience and technical support to help improve PANCAP’s capabilities to support its work at the international, country and community levels.

Mr Sidibé noted to participants that he recognised the need for strengthened technical support in the region. To this end he highlighted the importance of establishing a Technical Support Facility in the region.

During his intervention, Mr Sidibé highlighted the need to bring together all United Nations organizations working in the region under one action results framework. He also proposed the creation of an advisory group with representatives of CARICOM that could advise the UNAIDS Regional Director in identifying and coordinating priorities for an effective response to the epidemic in the region.

All participants agreed that the CARICOM – UNAIDS collaboration is producing positive results in the response to AIDS and reiterated their commitment to further strengthen the partnership.

The United Nations Secretary-General Mr Ban Ki-moon held a meeting in Geneva with HIV positive UN staff members and the UNAIDS Executive Director. The staff are part of a UN system-wide advocacy group called UN Plus which was set up in 2005 to promote the rights of HIV-positive staff and provide peer support.

Addressing the group, the Secretary-General reiterated his support to UN Plus and acknowledged his pride in the commitment and strength of its members.

UN Plus first met with Mr Ban in 2007, a meeting he described as “one of the most moving experiences of my life,” and today’s meeting was an opportunity for the group to update the UN Secretary-General on progress made and to request his continued support.

UN Plus Coordinator Bhatupe Mhango expressed her appreciation for work the Secretary-General has done in advocating for the rights of HIV positive people evidenced by his many meetings with people living with HIV when on official travel around the world.

The UNAIDS Executive Director, Michel Sidibé, also committed, personally and organizationally, to the vision of UN Plus and to continue to stand alongside and be a champion for all UN staff living with HIV. “The commitment to universal access includes universal access for all UN staff,” he emphasized.

The subject of inequality, including recognition of same sex domestic partnerships and health insurance, was central to the meeting’s agenda. The participants were in agreement that a harmonized approach across the UN system was needed to deal with the complexities of health insurance.

Since 2007 the group UN Plus, which is hosted and supported by UNAIDS, has grown to 150 members who include staff working in 41 countries in 21 UN agencies.

As part of its outreach strategy UN Plus has signed partnership agreements with other organizations, including FICSA (Federation of International Civil Servant Associations) and CCISUA (Coordinating Council of International Staff Unions and Associations). UN Plus has also continued to partner with key networks of people living with HIV including IFRC+, GNP+, ICW, and the newly-launched IPPF+ and has set up a women’s forum.

Such partnerships are at the core of UN Plus vision. As Kate Thomson, Head, Civil Society Partnerships Unit, UNAIDS noted to the Secretary-General, “UN Plus members have recently paved the way towards the adoption of a new agenda for Positive Health, Dignity and Prevention that will jointly bring UNAIDS together with positive networks globally for revitalized and collaborative efforts towards universal access.”

 

UN staff continue to have very real concerns about stigma towards those living with HIV. The Secretary-General was told that stigma remains a top concern as up to 80% of UN Plus members are undisclosed about their status. One of the participants from WHO, a mother, attended the meeting anonymously, underlining how real the personal and daily challenges of stigma and disclosure are.

For more on UN Plus visit its website: www.unplus.org

As global economic slowdown threatens to negatively affect those already most vulnerable to poverty, the achievement of the Millennium Development Goals (MDGs) around the world will require a change of scale in the implementation of innovative financing mechanisms for development.

To address this challenge, Dr Philippe Douste-Blazy, Special Advisor to the Secretary-General of the United Nations in charge of Innovative Financing, proposed the creation of a group which brings together eight finance initiatives, United Nations agencies and representatives of civil society.

The I-8 Group for the Millennium Development Goals held its first meeting in Geneva on 19 May 2009. The Secretary-General of the United Nations Mr Ban Ki-moon addressed the opening session, as did Dr Margaret Chan, Director-General of the World Health Organization (WHO) and Mr Michel Sidibé, Executive Director of UNAIDS.

The current economic crisis, according to UN Secretary-General Ban Ki-moon, makes innovative financing all the more important.

“We urgently need to strengthen and scale up existing innovative mechanisms, and explore new ones,” said the Secretary-General in his opening remarks. “This meeting will create a regular network of consultation, coordination and mutual reinforcement among innovative financing efforts worldwide.”

Mr Michel Sidibé spoke of how the I-8 or "innovative eight" could help bridge the gap between development needs and resources committed and build a more just, equitable and healthy world. He also reminded participants of the human aspect of the challenge: “If we are going to reach the Millennium Development Goals, we must avoid duplication, resist competition, and put people at the centre,” said Mr Sidibé.

A panel discussion on innovative financing mechanisms was moderated by Dr Patrice Debré, French Ambassador for the fight against HIV/AIDS and communicable diseases at the French Ministry of Foreign and European Affairs.

The I-8 Group for the Millennium Development Goals includes the following finance mechanisms:

1. The International Finance Facility for Immunization (IFFIm), created to support the Global Alliance for Vaccines and Immunizations (GAVI)
2. UNITAID
3. The Advance Market Commitments for vaccines
4. The “Debt 2 Health” initiative of the Global Fund to Fight AIDS, Tuberculosis and Malaria
5. (PRODUCT) RED
6. The Responsible Social Investment initiative of the Agence Française de Développement (AFD)
7. The use of revenues from the Carbon Market
8. Millennium Foundation for Innovative Finance for Health

The objectives of the first meeting of the informal network included agreement on a common framework for future information sharing, an exchange of experiences, and the development of a joint message on the consequences of the economic and financial crisis for the developing world.

The aim of I-8 is to share experiences, work on one common set of messages to reinforce the current initiative from the High-Level Taskforce on Innovative International Financing for Health Systems and the Leading Group on Solidarity Levies to fund Development, prepare the ground for new initiatives, and coordinate the channelling of resources in order to achieve maximum impact on the ground. Through this it is hoped that future initiatives, whether new ideas or the extension of existing initiatives, can be implemented as quickly and successfully as possible.

The event took place during the sixty-second World Health Assembly which runs in Geneva until 22 May 2009.

Ministers of Health of the Association of Southeast Asian Nations, or ASEAN, gathered for an informal meeting on the sidelines of the World Health Assembly (WHA) on 19 May 2009 in Geneva, Switzerland.

The main objective of the meeting was to discuss issues of common interest during the WHA, such as ASEAN’s strategies to address the A(H1N1) flu outbreak and prevent a pandemic as well as to discuss with UNAIDS Executive Director Mr Michel Sidibé strategies to achieve universal access to HIV prevention, treatment, care and support.

The meeting was chaired by Honorable Dr Francisco T. Duque III, Secretary of Health of the Philippines and supported by UNAIDS. It was a follow-up to the 2nd ASEAN-UN summit that took place in New York on 13 September 2005. In the New York meeting, participants adopted a Joint Communiqué stating the need for ASEAN members to have a voice in global forums such as the World Health Assembly and participate in global decision-making regarding allocation of funds for HIV prevention and control.

Mr Michel Sidibé, Executive Director of UNAIDS and Under Secretary-General of the United Nations presented his vision to the ASEAN countries and restated UNAIDS’ commitment to support countries in achieving universal access.

Mr Sidibé also outlined how a number of countries in the region have made significant progress in ensuring that the most vulnerable communities, including sex workers and their clients, men who have sex with men and injecting drug users, are a priority in national AIDS responses.

Mr Sidibé underscored the importance of government leadership in order to achieve the universal access targets and praised the commitment demonstrated by the ASEAN countries in responding to the AIDS epidemic as seen in their adoption in 2007 of the ASEAN Declaration on HIV and AIDS and the Declaration on the Protection and Promotion of the Rights of Migrant Workers.
At the end of the meeting, Health Ministers produced a Joint-ASEAN Ministerial Statement on ASEAN’s position in pandemic preparedness for avian, human and A(H1N1) influenza, particularly on cross-border collaboration, sharing of information and  viral specimens, and universal access on HIV prevention, treatment, care and support.

This year’s World Health Assembly is set to focus considerable attention on the widespread outbreak of influenza A(H1N1), as Health Ministers and officials of more than 190 countries gather in Geneva from 18-22 May to discuss the most effective responses to the potential pandemic, including preparedness, access to vaccines and sharing of influenza viruses.

According to the latest World Health Organization (WHO) statistics, there are now 39 countries reporting a cumulative total of 8480 cases of A(H1N1) (17 May update). The virus represents a serious and growing health threat. WHO Director-General Dr Margaret Chan has called for “global solidarity” in the face of this unpredictable threat and the sixty-second World Health Assembly will provide an opportunity for such solidarity.

The World Health Assembly, convened by the Director-General of the World Health Organization, will also follow its broad remit to review progress and set new priorities for the WHO. Other issues to be examined will include primary health care and health system strengthening; exploring the social determinants of health and monitoring the achievement of the health-related Millennium Development Goals. There will also be room for the discussion of the programme budget for the next two years and internal management matters.

A key element of the meeting is the consideration of the revised version of the Medium-term strategic plan 2008-2013 which has 13 objectives including the reduction of the health, social and economic burden of communicable disease; mitigating the health consequences of emergencies, disasters, crises and conflicts; ensuring improved access, quality and use of medical products and technologies, and challenging the spread of AIDS, tuberculosis and malaria.

Delegates hope to build on the success of previous meetings. For example, in 2008 the assembly endorsed a public health, innovation and intellectual property strategy which promoted new approaches to drug research and development and championed the removal of barriers, enhancing access to medicines, especially for less developed nations. The gathering also adopted a resolution urging Member States to take decisive action to address the health impacts of climate change.

It is clear that the World Health Assembly is expected to explore a complex array of issues that transcend the sphere of health, touching on and interconnecting with a broad range of other sectors with the aim of mounting an effective challenge to global health threats.

During the week, UNAIDS Executive Director Michel Sidibé will participate in a range of side events including meetings with national ministers of health from around the world.

UNAIDS and UNDP in West and Central Africa have signed a memorandum of understanding with the Forum of Arab and African Parliamentarians for Population and Development (FAAPPD) formalizing the commitment of the Parliamentarians to work towards the goal of universal access to HIV prevention, treatment, care and support services in the region.

Established in 1997, FAAPPD is an organization of parliamentarians constituted of the national networks of parliamentarians working on health issues, including HIV, in 61 African and Middle Eastern Countries.

The memorandum of understanding describes joint activities involving the regional partners in order to strengthen the role of the parliamentarians in a range of issues including leadership, law reform and ensuring the sustainability of the response to HIV through budgetary allocation.

Welcoming this important milestone of leadership for universal access, Dr Meskerem Grunitzky-Bekele, UNAIDS Regional Director for West and Central Africa and Mr Jean-Christophe Deberre, Deputy Regional Director, UNDP West and Central Africa noted that: “the role of parliamentarians in creating and strengthening societal dialogue on key issues such as access to HIV-related prevention, treatment and care services for the most marginalized and vulnerable is needed now more than ever.”

The signing of the memorandum of understanding is part of regional collaboration between partners UNAIDS, UNDP, UNICEF, UNODC, OHCHR, UNIFEM, UNFPA, ECOWAS, OSIWA, USAID and FAAPPD. By working together the partners hope to create an enabling environment for an effective AIDS response in West and Central Africa.

International labour migration, or the movement of people across national borders for employment, is a growing phenomenon and an increasingly important aspect of global, regional and national economies. However, HIV has become a key issue of concern with cross border and overseas migration.

Representatives of Pakistan, China, Thailand, Afghanistan, Bangladesh and Nepal together with senior officials from ILO, IOM, WHO and UNAIDS participated in a meeting on the issue during the 2009 62nd World Health Assembly. The meeting was a follow up on one held in Geneva during the 60th World Health Assembly in 2007. Initiated by the government of Pakistan, this year’s meeting highlighted the need to engage in inter regional dialogue between sending and receiving countries, especially countries under the Gulf Cooperation Council (GCC), to find ways to reduce the risks and vulnerabilities to HIV that migrant workers face.

Governments from Asian countries have raised their concerns regarding the large number of migrants in the region. At any given point in time, there are an estimated 58 million people on the move outside of their home countries within Asia and beyond. Outside Asia, the countries of the GCC region are the primary destination for a majority of migrant workers from the Philippines, Bangladesh, Sri Lanka and Pakistan.

The meeting provided a platform for Ministries of Health of sending countries in South and South East Asia to share experience on issues common to preparing workers for work outside the country especially in terms of reducing vulnerability to HIV and other health risks. The delegates also discussed how regional mechanisms, such as the Colombo process and the Abu Dhabi Dialogue, and international commitments could be harnessed to support dialogues and cooperation between sending and receiving countries as well as steps to developing a joint position/strategy to support negotiations and collaboration with receiving countries.

The meeting main objectives included:  

• To identify a strategy for inter sectoral collaboration between Ministry of Health and Ministry of Labour to address HIV vulnerability among migrant workers in the Asian region
• To set up a Task Force to ensure a course of action and progress review. One of the immediate actions would be to map which countries are implementing HIV prevention programmes for migrant workers, including pre-departure and post-arrival orientation, and identify gaps and potential partners/resources
• To involve UN and other organizations committed to the issue at country and regional level in both sending and receiving countries
• To involve non-governmental organizations working with/for migrants as key partners to monitor development of migrant issues in countries in the region

UNAIDS Executive Director Mr Michel Sidibé also participated in the meeting whose outcomes will be considered in the upcoming UNAIDS board meeting which will discuss the issue of forced displacement and migrant populations in relation to HIV and the challenges of assuring such populations universal access to HIV prevention, treatment, care and support.

Mr Sidibe highlighted the need for evidence-based strategies focusing on the needs of migrant populations. He also underlined the importance of political leadership for an effective response to AIDS that will involve all sectors of society.

Challenging process to work abroad

Although migration has become a part of the economic functioning of many countries – both sending and receiving – migrants are often not perceived as individuals with rights. They can be exploited, marginalized and stigmatized throughout the migration process. Studies show that mobile populations are vulnerable to discrimination, exploitation and harassment at home and abroad. Their basic rights could be violated in terms of pay and working conditions. Migrants have often little or no right to legal or social protection and generally lack access to HIV services and information.

In recent years, an increasing number of migrant workers from Asia have been diagnosed with HIV in various countries in the Arab States. Deportations due to HIV status have resulted in severe economic loss for migrant workers and their families, who have been declared by authorities as “unfit” to work abroad.

As part of the visa process in some countries, migrants must undergo a health test including HIV from a certified clinic. In most cases, the migrant is referred to a specific clinic that is approved by the receiving country. For example, all migrants going to a country in the GCC must attend clinics authorized by GCC Approved Medical Centers’’ Association. They are expensive and mostly located in capital cities, adding extra costs such as transportation and lodging.

There is little or no referral to treatment or support services for those who do have a health condition, including those who test positive for HIV. If found HIV positive, most countries in the region will deport a migrant worker without explanation, with little compensation, and no consideration for the migrant’s rights or dignity.

Given the large numbers of people on the move, ensuring their rights and access to HIV prevention, treatment and care and support services is a crucial component of an effective regional response to AIDS.

May 17 marks the International Day Against Homophobia which is an initiative to end discrimination and demand respect for the rights of homosexuals, transsexuals and lesbians.

Many countries in Latin America have planned activities to celebrate the Day such as marches, festivals, awareness raising workshops and campaigns to promote respect for sexual diversity.

UNAIDS Regional Director Dr Cesar Antonio Nuñez highlighted the need for all Latin American countries to observe the International Day Against Homophobia and Transphobia as an opportunity to strengthen the work being done around human rights to create a more effective response to AIDS in the region.

One of the new initiatives of this year’s celebration is an on-line campaign displaying messages against homophobia and transphobia. The campaign, which runs under the theme “For sexual rights and sexual diversity” was produced by the regional offices of UNAIDS and UNDP in collaboration with the Latin American Network of Transsexual People (REDLACTRANS), the Association for integral health and citizenship in Latin America (ASICAL) and the Latin American and Caribbean Council of AIDS Services Organizations for LAC (LACCASO).

“Let’s put an end to violence, let’s overcome the indifference” or “Homophobia accelerates the spread of HIV” are some of the campaign messages being displayed on web sites and played on YouTube. UNAIDS Brazil has adapted these spots into Portuguese.

Sex between men is the main mode of HIV transmission in Latin America and homophobia and stigma remain significant stumbling blocks to an effective response to the epidemic. Stigma and homophobia increase the isolation of gays, bisexuals and transgender people making them more reluctant to come forward, be identified and get advice and HIV services.

Many Latin American countries have laws that defend sexual freedom and orientation. For example with law reform in Nicaragua and Panama over the past 12 months, there are now no states in Latin America which criminalize homosexual relations.

Yet Latin America is widely regarded as having a long way to go to successfully counter homophobia, or “fear or hatred of homosexuals.” According to the UN, homosexual and trans people are frequently insulted, fired from jobs, and barred from community activities. .

Ahead of the International Day Against Homophobia (17 May), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Development Programme (UNDP) launched a new UNAIDS Action Framework on Universal Access for Men who have Sex with Men and for Transgender People. The Framework sets out how UNAIDS will facilitate and support universal access to HIV prevention, treatment, care and support for men who have sex with men and transgender people.

Acknowledging that ‘business as usual’ is no longer a viable response to the HIV-related risks of these groups, the Framework shows that collective responses to HIV in the men who have sex with men and transgender populations are failing. The problem has either been ignored – with insufficient data and analysis – or commitment and resources allocated to HIV programming in these populations fall far short of what is required.

“The failure to respond effectively has allowed HIV rates to reach crisis levels in many communities of men who have sex with men and transgender people,” said Michel Sidibé, Executive Director of UNAIDS. “Efforts to reverse this crisis must be grounded in human rights and underpinned by the decriminalisation of homosexuality,” he added.

The approach taken in the Framework aims to reduce the incidence of HIV everywhere, while protecting the health and rights of not only men who have sex with men and transgender people, but also their female sexual partners and the rest of the population. Responding to HIV among marginalized groups is therefore not just important in and of itself, it is often one of the most effective strategies to reduce heterosexual spousal transmission and to avert larger heterosexual epidemics. Universal access to appropriate HIV programmes for men who have sex with men and transgender people is a crucial part of achieving universal access as a whole.

“If we are going to make universal access for sexual minorities a meaningful reality, we must work towards ending homophobia and transphobia. We must address the legal and policy barriers,” said Jeffery O’Malley, Director of UNDP’s HIV group.

The Framework sets out how the UNAIDS Secretariat and its Cosponsors will work towards universal access for these often marginalized groups through three objectives:

(1) To improve the human rights situation for men who have sex with men and transgender people. In his statement to the International AIDS Conference in August 2008, the UN Secretary-General outlined the dangers of not protecting the legal and human rights of sex workers, drug users, and men who have sex with men, pointing out that in countries where such rights are enshrined in law, the result is fewer infections, less demand for antiretroviral treatment and fewer deaths.

(2) To strengthen and promote the evidence base on men who have sex with men, transgender people and HIV. Better quality data, from as wide a range of sources as necessary, is needed to inform, develop and advocate new policies and programmatic responses. UNAIDS and its Cosponsors will build upon their current work with partners to strengthen the knowledge base.

(3) To strengthen capacity and promote partnerships to ensure broader and better responses for men who have sex with men, transgender people and HIV. Ensuring sufficient capacity in intergovernmental, governmental and nongovernmental organizations to appropriately address diverse sexuality and HIV is vital if men who have sex with men and transgender people are to get universal access to HIV-related services. The Framework sets out how the scale-up of capacity can be achieved.

The joint UNAIDS programme, utilizing the strengths of all its Cosponsors, is committing itself to interagency UNAIDS action to improve global and national HIV-related efforts for men who have sex with men and transgender people.

An interagency working group will develop a system to monitor and evaluate the approach and work proposed in the Framework, develop the strategic approach of UNAIDS and its Cosponsors’, develop, monitor and evaluate detailed workplans, periodically review and evaluate their strategic approach and report on the activities undertaken.

By signing the 2006 United Nations Political Declaration on HIV/AIDS, governments committed to removing legal barriers and passing laws to protect vulnerable populations. However, over 80 countries still criminalize consensual same sex acts among adults.

It is against this repressive context that communities worldwide celebrate the International Day Against Homophobia each 17 May, which marks the anniversary of the World Health Organization’s decision to remove homosexuality from its list of mental disorders in 1990. Therefore, 17 May is an opportunity to highlight once again the urgent need for joint efforts to reduce and end discrimination, violence and criminalization based on sexual orientation.

Homophobia and criminalization of consensual adult sexual behaviour represent major barriers to effective responses to HIV. Such responses depend on the protection of the dignity and rights of all people affected by HIV, including their right and ability to organize and educate their communities, advocate on their behalf, and access HIV prevention and treatment services.

“The decision to criminalize same sex relations is a serious setback to the AIDS response and to the rights of those affected by the law,” said Michel Sidibé, Executive Director of UNAIDS. “As these discriminatory laws can drive people underground, they will have a negative impact both on the delivery of HIV prevention programmes and on access to treatment for those living with HIV.”

Evidence shows that protection of the rights of men who have sex with men, lesbians and transgenders, both in law and practice, combined with scaled-up HIV programming to address their HIV and health needs are necessary and complementary components for a successful response to the epidemic.

UNAIDS urges all governments to take steps to eliminate stigma and discrimination faced by men who have sex with men, lesbians and transgenders and create social and legal environments that ensure respect for human rights and universal access to HIV prevention, treatment, care and support.

“There is no place for homophobia. Universal access to HIV prevention, treatment, care and support must be accessible to all people in need—including men who have sex with men,” said UNAIDS Executive Director Michel Sidibé.

Countries that have non-discrimination laws against men who have sex with men, injecting drug users and sex workers have achieved higher rates of coverage of HIV prevention efforts.