The Ambassador of Finland Mr Hannu Himanen (left) met with UNAIDS Executive Director Michel Sidibé in Geneva, 14 May 2009. Credit: UNAIDS

As a sign of its long-term commitment to the AIDS response and partnership, the Government of Finland has committed to increase its contribution to UNAIDS by 25% in 2009. The news of this increase in contribution was personally delivered to UNAIDS Executive Director Michel Sidibé by the Ambassador of Finland Mr Hannu Himanen in a meeting held in Geneva.

Coming just days after the 2009 UNAIDS Nordic Consultations, this contribution underscores Finland’s commitment to sustain and enhance UNAIDS work during the current financial and economic crisis.

According to Ambassador Himanen, “It is important to link primary health care systems with AIDS. Finland would like to work with UNAIDS to make this possible.”

“The success story of Finland’s approach of integrating AIDS in community systems is a social revolution,” said Michel Sidibé. “UNAIDS is proud to count Finland as a true partner in the global AIDS response.”

UNAIDS Executive Director Michel Sidibé (left) met with Mr Ion Bazac, Minister of Health of Romania, in Bucharest on 12 May 2009.
Credit: UNAIDS/E. Petrescu

During an official visit to Bucharest, UNAIDS Executive Director Michel Sidibé yesterday met with Mr Ion Bazac, Minister of Health of Romania.

The Executive Director praised Romania’s significant achievement of universal access to HIV treatment for all people living with HIV in need of it.

The meeting was an opportunity to discuss the importance of sustaining Romania’s success in the AIDS response during the current financial and economic crisis.

Mr Sidibé described AIDS as an opportunity to make progress on larger health and development goals through the integration of HIV services with wider health services including treatment of tuberculosis as well as sexual and reproductive health.

Minister Bazac reiterated Romania’s commitment to sustain HIV prevention activities that are currently being supported by the Global Fund to Fight AIDS, TB and Malaria. Minister Bazac also invited UNAIDS to collaborate with the Romania’s new training academy for HIV/AIDS and infectious diseases, which will be launched next month in Bucharest.

UNAIDS Executive Director Michel Sidibé (left) met with Bogdan Aurescu, Secretary of State of the Romanian Ministry of Foreign Affairs.
Credit: UNAIDS/E. Petrescu

In a later meeting with Bogdan Aurescu, Secretary of State of the Romanian Ministry of Foreign Affairs, Michel Sidibé discussed the potential for Romania to take a leadership role on political advocacy for AIDS and human rights, particularly in the European Union. Aurescu, a well-known legal expert and diplomat, expressed Romania's readiness to engage the European Union and the Council of Europe in these areas. The Secretary of State also expressed Romania's high regard for collaboration with UN and his commitment to sustain policy development, advocacy and technical cooperation on HIV through UNAIDS.

A version of this story first appeared on unicef.org

During a recent visit to a youth centre in the capital, Vientiane, Mr Ban met representatives of people living with HIV (PLHIV) including Mr Kinoy, from the Lao Network of People Living with HIV (LNP+).
Photo credit: UNICEF
Lao PDR/2009/Holmes.

The United Nations Secretary-General, Mr Ban Ki-moon, praised the efforts of the UN Country Team and its partners to support prevention, treatment, care and support activities for people living with HIV, and to raise knowledge and understanding of the issue in Lao PDR.

During a recent visit to a youth centre in the capital, Vientiane, Mr Ban met representatives of people living with HIV (PLHIV) including Mr Kinoy, from the Lao Network of People Living with HIV (LNP+).

Mr Kinoy thanked the Secretary-General for all the UN’s support to PLHIV in the Lao PDR. He said it was vital to ensure continued free access to treatment, care and support services for all in need, to address stigma and discrimination at all levels, and to strengthen the participation of PLHIV in the national response to AIDS.

The Joint UN Team on AIDS in Lao PDR is supporting PLHIV and a greater involvement of people living with HIV in many parts of the country, through capacity building, direct support for activities, and resource mobilization efforts. UNAIDS advocates for meaningful involvement of people living with HIV as one of the key elements of a continuously successful response to AIDS in the country.

UNAIDS, together with a support consortium consisting of several partners, works closely with LNP+ in developing the network as “the voice” of PLHIV. Support is also provided to local level PLHIV support groups to strengthen their self management and representation.

Mr Ban told the young reporters about his recent meeting with UN+ (the UN system HIV positive staff group) and his personal commitment to address stigma and discrimination.
Photo credit: UNICEF
Lao PDR/2009/Holmes.

“I am very much impressed by all that you are doing to help young people of Laos, to teach them awareness and the importance of prevention of HIV/AIDS,” the Secretary General told reporters from a UNICEF-supported youth radio programme.

He told the young reporters about his recent meeting with UN+ (the UN system HIV positive staff group) and his personal commitment to address stigma and discrimination.

Although rates of HIV infection are low in Laos compared to other parts of South East Asia, there are signs that it is gaining hold among some adolescent groups.

During his visit to the Vientiane Youth Centre, Mr Ban applauded the work being done by young counselors and volunteers – including a group of Buddhist monks – for helping people living with HIV to overcome stigma and integrate into society.

Pointing out that the global response to AIDS was a priority for the UN, Mr Ban added: “This is very important for the community, the government, and citizens of Laos to work together, to provide good counseling, provide good care and support and good source of encouragement to people living with HIV”.

During his visit to the Vientiane Youth Centre, Mr Ban applauded the work being done by young counselors and volunteers – including a group of Buddhist monks – for helping people living with HIV to overcome stigma and integrate into society.
Photo credit: UNICEF
Lao PDR/2009/Holmes.

Established in 2001 under the Lao Women’s Union, the Vientiane Youth Centre is a pioneering initiative designed to promote youth capacity development and empowerment. With assistance from the UN Population Fund, the UN Office on Drugs and Crime and UNICEF, the Centre supports a telephone hotline offering advice on AIDS issues, a clinic providing reproductive health services and peer-to-peer education.

Earlier during his visit to Laos (the first by any Secretary-General in nearly a quarter of a century), Mr Ban held talks with His Excellency, Choummaly Sayasone, President of the Lao PDR, and other government leaders. In an address at the inauguration ceremony for a new UN headquarters, the Secretary General said he was optimistic that Lao PDR would achieve the Millennium Development Goals and graduate from Least Developed Country (LDC) status by the target date it has set itself of 2020.

The Secretary-General described a newly-released Millennium Development Goals report as a valuable tool for the Government and its development partners. To achieve the improvements still required in several areas, he called for “greater investments in human development, the social sector and environmental sustainability.”

In an address to more than 200 UN staff members working here, Mr. Ban said fostering a collaborative spirit among the various UN agencies was the most effective means of promoting development.

UNAIDS Executive Director Michel Sidibé praised Viet Nam’s efforts to reach its universal access goals in a meeting with Viet Nam’s Deputy Prime Minister H.E. Mr Truong Vinh Trong in Paris.

UNAIDS Executive Director Michel Sidibé praised Viet Nam’s efforts to reach its universal access goals in a meeting with Viet Nam’s Deputy Prime Minister H.E. Mr Truong Vinh Trong in Paris. The meeting took place on 28 April during a study visit to the Netherlands and France.

The two leaders discussed specific measures to reach Viet Nam’s universal access goals, including strengthening multisectoral coordination in the AIDS response, the intensification of comprehensive prevention and harm reduction programmes with inclusion of substitution therapies and new approaches to address sex work.

The Deputy Prime Minister in endorsing Mr Sidibé’s bold priorities stated that, “Viet Nam is doing its best to make sure its people are protected from HIV.”

Study visit to review experience in the area of drugs and sex work prevention and management

Mr Truong Vinh Trong also shared the findings of the Viet Nam delegation’s study visits to the Netherlands and France during which they reviewed policy, practice and experience in the area of drugs and sex work prevention and management.

Mr Sidibé commended the leadership of Mr Trong in taking senior leaders from the Viet Nam National Committee on AIDS, Drugs and Prostitution on the research visit. Members of the high-level government delegation included Mr Le The Tiem, Vice Minister, Ministry of Public Security; Mr Bui Hong Linh, Vice Minister, Ministry of Labour, Invalids and Social Affairs; and Professor Trinh Quan Huan, Vice Minister, Ministry of Health.

The visit included meetings with Dutch and French Ministers and officials from the Health and Foreign Affairs ministries and visits to facilities that provide services for people living with HIV and programmes for people who inject drugs, sex workers as well as research institutes and a prison. Mr Trong explained that senior members of the National Committee accompanied him on the visit to ensure that lessons learned would be incorporated in Viet Nam’s national response to AIDS.

Progress towards universal access

Although the country faces challenges to meet its universal access targets, Viet Nam has made significant progress in some areas. Expansion of coverage and access to quality HIV treatment and care have been considerably improved in those areas with high HIV prevalence since the targets were set in 2006. There has been a 50% increase in the number of eligible pregnant women receiving antiretroviral treatment, and a six-fold increase in access to antiretroviral treatment. Methadone pilot sites started operation in two provinces in 2008.

The UNAIDS Executive Director was invited by the Deputy Prime Minister to attend the opening of the conference on the commemoration of 20 years of Viet Nam’s response to HIV to be held in Hanoi in 2010.

The Miller School of Medicine of the University of Miami and the Fogarty International Training Programme on AIDS and TB organized in collaboration with UNAIDS the ‘Health Research in the Americas V’ Conference on 7 and 8 May 2009, in Miami, Florida.

The aim of the conference was to highlight current evidence on HIV prevention, discuss the sustainability of comprehensive HIV prevention efforts as well as to debate how HIV prevention is situated within the broader discussion of ‘health in the Americas’ and other international development strategies.

Sir George Alleyne, Special Envoy of the United Nations Secretary General for HIV/AIDS in the Caribbean, was invited as a keynote speaker on the second day of the conference.

Numerous local and national achievements in curbing the epidemic have created a body of evidence about what works, but these successful approaches have not yet been fully applied.

At the conference, scientists, HIV prevention practitioners and policy makers explored scientific and programme experiences for prioritizing comprehensive, evidence-informed HIV prevention approaches and discussed effective solutions that could bridge the interface between HIV and other health and development issues.

The conference was open to behavioral scientists and researchers who work in the area of HIV prevention in the Americas, with a special focus on Guyana, the Dominican Republic, Jamaica, Brazil, Colombia and Peru.

Mr Erik Solheim, the Norwegian Minister of International Development and Environment (left) meets Mr Michel Sidibé, UNAIDS Executive Director in Oslo, 7 May 2009
Credit: Secretariat of the Minister of International Development, Norway

The Nordic countries are staunch supporters of the global AIDS response and have supported UNAIDS both politically and financially since its inception. This week UNAIDS met with four Nordic countries, Norway, Sweden, Denmark and Finland to exchange knowledge and outline priorities for the upcoming year.

The Nordic countries place great emphasis on the informal and interactive format of these annual consultations with UNAIDS which this year were hosted by Norway in Oslo.

“The Consultations are a true example of a genuine partnership – and cooperation among friends,” said Michel Sidibé, Executive Director of UNAIDS. “We hold honest discussions which provide essential feedback for UNAIDS’ work,” he added.

Topics up for discussion this year included vulnerable populations, including migrants; dealing with the financial crisis; linking the AIDS response and the Millennium Development Goals; health system strengthening and delivery; and where UNAIDS should be in the global health architecture.

During the visit to Oslo, Mr Sidibé also met with the State Secretary Solveig Torsvik, the Deputy Secretary General, Atle Leikvoll, the Minister of International Development and Environment Erik Solheim.

Mr Michel Sidibé, UNAIDS Executive Director visited Her Royal Highness Crown Princess Mette Marit in Oslo on 7 May 2009
Credit: Sara Johannesen, Scanpix

Mr Sidibé also took the opportunity to visit Her Royal Highness Crown Princess Mette Marit.

The Crown Princess renewed her support to UNAIDS and discussed a number of initiatives she is currently involved in including the aids2031 Young Leaders Summit which is taking place in Oslo next month where she pledged to raise awareness about HIV and young people.

The Crown Princess has been working with UNAIDS since 2006, helping to generate awareness and support for young people living with HIV. In 2008 while visiting Ukraine she met with young people involved in peer education and people living with HIV as well as many others working in the country’s AIDS response. The Crown Princess has also used her status to raise awareness around women and HIV, notably during the XVI International AIDS Conference in Toronto in 2006 and during a fact finding mission to Nicaragua in 2007.

The meetings in Oslo concluded on Friday with a dialogue between participants and Nordic civil society groups.

UNAIDS Executive Director Michel Sidibé opened a technical session on “The Global Fund's role as a strategic and responsible investor in HIV/AIDS” during the 19th Board Meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Geneva, 6 May 2009.
Credit: Global Fund to Fight AIDS, Tuberculosis and Malaria/Philippe Christin

The 19th Board Meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) concluded yesterday in Geneva, Switzerland. Opening a technical session on “The Global Fund's role as a strategic and responsible investor in HIV/AIDS” earlier, UNAIDS Executive Director Michel Sidibé reaffirmed UNAIDS commitment to its partnership and reiterated his call for a fully funded Global Fund. He called for bolder action in order to address the challenges facing the AIDS response.

Michel Sidibé spoke of the need for smarter investments in the AIDS response: “as long as there are five people newly infected for every two people starting HIV treatment we will not change the trajectory of the epidemic.” He also called for the virtual elimination of mother-to-child transmission by 2015.

Mr Sidibé emphasized the importance of the mechanism provided by the Global Fund in addressing global health challenges and identified this time of economic crisis as an opportunity for change: “in this time of crisis, today’s topic - investing strategically and responsibly – is needed now more than ever.”

Investing in the AIDS response

Elizabeth Mataka, UN Special Envoy of the Secretary-General for HIV/AIDS in Africa spoke during the technical session on “The Global Fund's role as a strategic and responsible investor in HIV/AIDS” during the 19th Board Meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Geneva, 6 May 2009.
Credit: Global Fund to Fight AIDS, Tuberculosis and Malaria/Philippe Christin

The session was jointly developed by UNAIDS, UNICEF, WHO and the office of the Global Fund Chair.

Two aspects in particular were explored: ways to reduce costs while simultaneously improving quality of care to people living with HIV; and how to improve grant effectiveness targeting prevention of mother-to-child transmission of HIV and pediatric AIDS treatment through promoting integrated efforts.

Participants also discussed how the Global Fund can achieve higher impact in its investments and play a more effective role as a financing instrument and a partnership in supporting a comprehensive approach to HIV.

Mr Sidibé outlined the challenges needed to achieve universal access to HIV prevention, treatment, care and support which include country owned and evidence driven responses grounded in human rights. He spoke of the key role the Global Fund plays in this.

“The Global fund is a key partner in the global movement to achieve universal access. It is among the most innovative and results-driven health financing mechanisms ever established,” said Mr Sidibé.

Mr Sidibé referred to UNAIDS Outcome Framework emphasizing the importance for UNAIDS —Secretariat and Cosponsors— to focus on areas where it has a comparative advantage and can make a difference to accelerate progress in AIDS and strengthen synergies with the other Millennium Development Goals.

The session considered how to address the increasing costs of meeting the treatment needs of people living with HIV, and identified the need for significant success in preventing new infections in order to get ahead of the AIDS epidemic.

The 19th Board Meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria took place in Geneva 5-6 May 2009
Credit: Global Fund to Fight AIDS, Tuberculosis and Malaria/Philippe Christin

The two day board meeting also included a review of strategy in relation to sexual orientation and gender identity and a presentation of a five-year evaluation report examining partnerships at global and country levels and impact these relationships have on the successful implementation of Global Fund grants. Recognizing the overall achievements of the Global Fund in its first six years, the evaluation highlighted a number of areas where it suggests improvements are required in the establishment of more effective partnerships.

The Global Fund is the world's largest funding mechanism of programmes addressing AIDS, tuberculosis and malaria. A total of US$ 15.6 billion has been approved for programmes in 140 countries and with expected disbursements of US$ 2.9 billion in 2009.

People living with or affected by HIV often require practical assistance to maintain adequate housing, keep child custody, enforce property and inheritance rights, or access health care, education or employment without discrimination.
Credit: UNAIDS/P.Virot

Experience in the response to AIDS has shown that access to legal services is an important part of guaranteeing protection from discrimination, getting redress for human rights violations, and expanding access to HIV prevention and treatment. Yet such programmes are not sufficiently supported by national AIDS responses, and where they do exist, quality and scale are often insufficient.

The International Development Law Organization (IDLO), the UNAIDS Secretariat and the United Nations Development Programme (UNDP) hosted an international expert consultation on strengthening and expanding HIV legal services at IDLO headquarters in Rome, 3-6 May.

Meeting participants contributed to the development of tools for improving access to legal services for people living with HIV and key populations at higher risk of HIV infection, particularly those in low- and middle-income countries. The tools will support countries to develop and strengthen programmes and proposals for funding, including to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Susan Timberlake, Senior Human Rights and Law Adviser with the UNAIDS Secretariat, explains that UNAIDS advocates that access to justice must be a basic, programmatic component of the movement for universal access to HIV prevention, treatment, care and support. “The persistent reality of discrimination – whether due to HIV status, gender, or social status – means that legal services are a critical and necessary part of a comprehensive response to the epidemic,” says Timberlake.

People living with or affected by HIV often require practical assistance to maintain adequate housing, keep child custody, enforce property and inheritance rights, or access health care, education or employment without discrimination. Access to legal services is even more important in punitive legal environments. An increasing number of countries are passing overly-broad laws to criminalize HIV transmission. Men who have sex with men, sex workers and people who use drugs face criminal sanctions in many countries, blocking access to HIV services and heightening HIV vulnerability. According to research commissioned in 2008 by the International Task Team on HIV-related Travel Restrictions, some 60 countries deny entry, stay and residence based on HIV status.

No “one size fits all” for legal services

Legal services in the context of HIV take many forms. These include: legal information and advice, including through telephone “hotlines”; formal litigation, including strategic litigation to create legal policy; mediation and other forms of dispute resolution; assistance with informal or traditional legal systems (e.g. village courts); and community legal education. Legal service providers are not always lawyers. They may be paralegals, volunteers, students or peer educators. Such services are provided in a range of settings, including HIV treatment and counselling centres, “mainstream” legal aid centres, as well as prisons and community settings. Work may also be linked to advocacy for law reform.

According to Mandeep Dhaliwal, Cluster Leader on Gender, Human Rights & Sexual Diversities with the UNDP HIV Practice, the rationale for supporting HIV legal services rests on two related arguments. “One, they are essential as a means to protect the human rights of marginalized and vulnerable populations. Two, they are essential as a means to ensure optimal public health and development outcomes – both of which are underpinned by the realization of rights,” says Dhaliwal.

However, too often such programmes do not get the support they need. “One of our goals as the Joint UN Programme on HIV/AIDS is to support countries to recognize how important legal services can be to their national HIV response, and then work with them to develop a strategy to scale-up these services,” explains Dhaliwal. “Existing HIV legal services are generally small in scale and patchy in coverage. With high levels of ‘legal’ marginalization of vulnerable populations, the achievement of universal access to prevention, treatment, care and support demands a commitment to legal protection and access to legal services.”

The meeting in Rome supported the development of three tools to improve access to HIV legal services:

1. Models of legal services applicable in different situations
2. Training curriculum for lawyers
3. Resource mobilization strategies.

“There are extraordinary examples of great work being done to provide legal services. We know the importance of providing an enabling legal environment to HIV prevention and treatment access,” says David Patterson, Manager of IDLO's HIV and Health Law Programme, “Why have such legal services not been taken to scale with the same urgency that we seek to provide treatment?”

Participants included legal service providers and leaders of organizations working with people living with HIV, women’s groups, people who use drugs, men who have sex with men and sex workers, as well as representatives from IDLO, UNAIDS, UNDP, and the Global Fund. They came from diverse countries and epidemic settings, including Australia, Botswana, Brazil, China, Denmark, Egypt, Georgia, Guatemala, India, Indonesia, Nepal, Papua New Guinea, St Lucia, Uganda, Ukraine, the United States of America and Viet Nam.

The five booklets in UNESCO’s Good Policy and Practice in HIV & AIDS and Education aim to help education sectors in developing countries mount an effective response to HIV.

The negative impact of HIV is felt on education systems and schools, learners and teachers around the world from children dropping out of school to care for sick parents to the loss of teachers in their most productive years. As part of efforts to support governments, donors, NGOs, education planners and managers, school governing bodies and teachers in dealing with the implications of the epidemic and to share knowledge on effective responses, UNESCO has developed a best practice series entitled Good Policy and Practice in HIV & AIDS and Education.

The booklets in the series are broad in scope and highlight issues and lessons learned in a range of settings in developing countries. They examine policies, programmes and activities by a variety of actors and draw lessons from case studies and a review of both published and unpublished literature.

Credit: Copyright 2003 Harvey Nelson, Courtesy of Photoshare.

Out-of-school learners are also a focus of the series. For example, in Zambia, an interactive radio programme which provides access to education in an informal setting, for children who are unable to attend school is featured. Produced by the Ministry of Education Broadcasting Services Department, the weekday shows integrate life skills and HIV prevention into lessons on literacy, mathematics and other subjects. Drama, songs and participatory activities are used to introduce the lessons. The project, operating in 450 sites, covers 180,000 children, most of them orphans, and almost 50% of them girls.

UNESCO hopes that a best practice in one educational institution, ministry, country or region can be adapted and used effectively elsewhere.

The first booklet provides an overview and examines policy and programme responses. It also focuses on the need for more data and research around education sector responses to the AIDS epidemic.

The second has learners at its centre: their rights to education, protection, knowledge and skills, and care and support. One aspect examined is the exploration of successful prevention programmes for young people. In Namibia, for instance, the My Future is My Choice project has operated for over 10 years promoting AIDS prevention in schools. It aims to protect young people from HIV and other sexually transmitted infections, unwanted pregnancies and alcohol and drug abuse, by encouraging them to think for themselves and take responsibility for their future and their own development.

Credit: Copyright 2005 Netsanet Assaye, Courtesy of Photshare

In booklet three, attention is turned towards educators and their role. It discusses their needs for training, care and support and the importance of their conduct in ensuring safe and secure learning environments. The fourth concentrates on the importance of strategic partnerships at multiple levels (i.e. global, regional, and within countries), of involving people living with HIV, and of working with children and young people. The fifth and final booklet in the series explores effective learning and quality education. It summarizes factors contributing to effective learning in the context of AIDS education and highlights issues to consider in developing and adapting relevant learning materials.

For UNESCO, Good Policy and Practice in HIV & AIDS and Education is a ‘living’ resource which will be expanded and refined as new knowledge and strategies become available. This series is considered a tool, a stepping stone, to support the education sector’s full engagement in national responses to the AIDS epidemic.

"Swine influenza"
Credit: C. S. Goldsmith and A. Balish, CDC

There are many questions concerning the potential impact of emerging influenza A(H1N1)* on people living with HIV, as they are more susceptible to opportunistic infections.

There is no documented information on clinical interactions between HIV and influenza A(H1N1) virus, whose transmission, incubation period and clinical manifestations have generally been similar to those of seasonal influenza viruses. Although there are inadequate data to predict the impact of a possible human influenza pandemic on people living with HIV, interactions between HIV and A(H1N1) influenza could be significant. Country preparedness plans for influenza should address the needs of people living with HIV, and national AIDS plans, especially in high HIV prevalence countries, should consider public health action required in case of pandemic influenza.

The World Health Organization has prepared a guidance note to assist countries and health workers in understanding the relevant risks and taking appropriate measures.

*As of 30 April 2009, WHO refers to the new influenza virus as influenza A(H1N1).