"Women and men: United to end violence against women" is the theme of this year’s International Women's Day which is observed at the United Nations on 5 March 2009 and celebrated internationally on 8 March.

Sexual violence, and the threat of violence, increases women’s vulnerability to HIV and in certain parts of the world is being used as a tactic of war.

UN Secretary-General Ban Ki-moon highlights this in his message marking International Women’s Day: “Violence against women is also linked to the spread of HIV/AIDS. In some countries, as many as one in three women will be beaten, coerced into sex or otherwise abused in her lifetime. Women and girls are also systematically and deliberately subject to rape and sexual violence in war.”

UNAIDS Executive Director Michel Sidibé is also unequivocal on the need to end this violence in his statement: “Violence, including rape and sexual abuse against women and girls should not be tolerated in any circumstances, be it in conflict or war or at home in our own communities.”

Sexual violence in conflict has not been a high priority for security institutions and is often overlooked due to stigma and under-reporting. However, the trauma and terror of rape can wound as deeply as bullets and in areas with high HIV prevalence, women are also at risk of being infected with HIV.

Leo Kenny, Team Leader of UNAIDS Security and Humanitarian Response is convinced of the pressing need to address the issue sexual violence among the uniformed services: “While soldiers and uniformed service personnel have been perpetuators of violence against women, they have also been part of the solution and are potential key agents of change if the right programmes are put in place.”

“Educating and involving peacekeepers in addressing sexual violence is important as soldiers have influence among their peers both within the service and the wider community. By changing their perceptions and behaviours it can positively impact the larger population,” Mr Kenny added.

The women who survive sexual violence need access to comprehensive health and counselling services and, where necessary, HIV prevention, treatment, care and support. However the context of civil unrest can result in barriers to universal access to these services.

There is also a need for the millions of uniformed service personnel worldwide to be integrally considered in the scale up towards universal access to HIV prevention, treatment, care and support.

UN Action against Sexual Violence in Conflict

"Women and men: United to end violence against women" is the theme of this year’s International Women's Day which is observed at the United Nations on 5 March 2009 and celebrated internationally on 8 March. Credit: UNAIDS

Two years ago today, UN bodies came together to form a joint initiative, “UN Action against Sexual Violence in Conflict.” The partnership now stands at twelve UN entities which seek to draw attention to the issue of sexual violence in conflict and the need to do more, to improve the quality of programming to address sexual violence, to increase the coordination of efforts for comprehensive prevention and response services, and to improve accountability as well as to respond effectively to the needs of survivors.

The UN Action initiative is designed to create greater awareness of these abuses and, ultimately, end sexual violence to make the world safer for women and girls.

Three main pillars

The first aspect of this initiative, country level action, involves country level support and efforts to build capacity and train advisers in gender-based violence programming and coordination, as well as support for joint UN programming in selected countries.

Second, “advocating for action”, raises public awareness and generates political will to address sexual violence as part of the broader campaign to “Stop rape now.” The third aspect is the creation of a knowledge hub on sexual violence in conflict and effective responses.

Stop rape now

Rape has deep roots in a historical absence of accountability and UN Action has helped catalyze a paradigm shift: insisting that sexual violence is recognized as a security threat that demands a security response, rather than simply an inevitable byproduct of war.

International Women’s Day

In 1977 the UN General Assembly adopted a resolution inviting Member States to proclaim a United Nations Day for Women's Rights and International Peace—International Women's Day—in recognition of the fact that securing peace and social progress and the full enjoyment of human rights and fundamental freedoms require the active participation, equality and development of women; and to acknowledge the contribution of women to the strengthening of international peace and security.

For women around the world, the symbolism of International Women's Day has a wider meaning: it’s an occasion to celebrate how far women have come in their struggle for equality and an opportunity to unite, network and mobilize for meaningful change.

The President of the Republic of Costa Rica, Mr Óscar Arias signing the HIV prevention and education agreement.

Young people in Costa Rica will be receiving information on HIV prevention and healthy lifestyles from their peers thanks to a new agreement signed in San Jose by the Government of Costa Rica and the United Nations.

The agreement establishes that young people, aged 15 – 25 years, will lead in sharing sexual health information among their peers in two provinces: Limón and Puntarenas. The young leaders will provide education on a wide range of issues such as modes of HIV transmission and how to use a condom.

UNAIDS Regional Director Dr César Núñez emphasized that only timely information and HIV prevention can stop the spread of HIV. “It is urgent to provide young people with HIV information and to include sexual education in the school curriculum, as well as to develop specific strategies for the population outside schools,” he said.

The agreement was signed on 24 February 2009 by the President of the Republic Mr Óscar Arias and the Deputy Minister of Youth Karina Bolaños together with Dr César Núñez, UNAIDS Regional Director, Nils Kastberg, UNICEF Regional Director for Latin America and the Caribbean, Luis Mora, UNFPA Regional Adviser in Gender and Masculinities, and young people from the Limón and Puntarenas provinces.

A 2008 study carried out by UNFPA and UNICEF with support from UNAIDS showed that the majority of young people in Costa Rica were sexually active at the age of 16. The study also highlighted that there was lack of HIV information and knowledge among Costa Rican youth.

For that reason, President Arias, who received a Nobel Peace prize in 1987, emphasized on the occasion of the signing the need to speak about sexual education openly and without prejudices. “Talking about sex cannot continue to be taboo in Costa Rica,” he said.

The President of the Republic of Costa Rica, Mr Óscar Arias (centre) talking with the United Nations representatives that signed the agreement.

The study shows that in Limón only about 28% of the young people interviewed know how to use a condom correctly whereas in Puntarenas the percentage drops to about 17%. Furthermore, in both provinces, more than 50% of the adolescents find that asking a partner to use a condom could be interpreted as a sign of mistrust. Finally, 43% in both provinces think that a young girl carrying condoms in her purse is a woman with a “doubtful reputation.”

The agreement signed will look at strengthening the capacity of the health and education institutions as well as youth and adolescents in the country to promote HIV prevention. UNICEF, UNFPA and UNAIDS will provide technical and financial assistance to the programme which plans to directly benefit 73,000 adolescents.

This agreement is a direct result of the Meeting of Ministers of Education and Health to prevent HIV in Latin America and the Caribbean, that took place in Mexico in August 2008 ahead of the International AIDS Conference, when Ministers signed an historic declaration pledging to provide comprehensive sex education as part of the school curriculum in Latin America and the Caribbean.

Opening session of the meeting of the Commission on the Status of Women. United Nations, New York, 2 March 2009
Credit: UN Photo/Jenny Rockett

Equal sharing of responsibilities between women and men, including care-giving in the context of HIV is the theme of the 53rd session of the United Nations Commission on the Status of Women (CSW) which opened today at UN Headquarters in New York.

Addressing the opening of the 53rd session, UNAIDS Executive Director Michel Sidibé called for bold, collective action to achieve universal access and to achieve gender equality.

“Gender equality must become part of our DNA -- at the core of all of our actions. Together with governments and civil society, we must energize the global response to AIDS, while vigorously advancing gender equality,” said Mr Sidibé. “These causes are undeniably linked.”

Mr Sidibé highlighted three priority actions needed to make this a reality: integrated delivery of antenatal, sexual and reproductive health and HIV services; respect and protection of human rights; and new models of development in which women and men have greater control over their lives.

Caregiving and HIV

The majority of people experiencing ill health due to HIV live in low and middle-income countries and are being cared for at home, since health services may be beyond the reach of large proportions of the population. Home and community-based care takes many forms, but typically it is provided by relatives, friends, or community volunteers.

UNAIDS Executive Director Michel Sidibé (front, right) gave a keynote address at the opening.
Credit: UNAIDS

The burden of this care-giving lies disproportionably on women because of gender norms—the widely held beliefs, expectations, customs and practices within a society define ‘masculine’ and ‘feminine’ behaviours and roles and responsibilities.

Promoting a more equitable sharing of responsibilities between women and men is a practical necessity but alone is not enough to address the current inequalities, said Mr Sidibé.

“Women and girls need legislative and judiciary initiatives, policies and community-driven programmes. These are essential to ensure access to economic resources, social protection and safety nets, and access to education, skills training and employment.”

Fifty-third session

Equal sharing of responsibilities between women and men, including care-giving in the context of HIV is the theme of the 53rd session of the United Nations Commission on the Status of Women (CSW) which opened today at UN Headquarters in New York.

Over the coming days, participants, including representatives of Member States, UN entities and ECOSOC-accredited non-governmental organizations from all regions of the world will explore the theme through a series of interactive sessions.

There will be a roundtable for high-level participants including ministers, deputy-ministers and principal secretaries to focus on experiences and lessons learned.

Technical experts will hold a panel to identify policy initiatives to accelerate the implementation of previous commitments and along with statisticians will hold another panel on capacity-building for gender mainstreaming in relation to care-giving in the context of HIV. This will provide an opportunity for an exchange of national and regional experiences and good practices.

Commission on the Status of Women

The Commission on the Status of Women is a commission of the United Nations Economic and Social Council (ECOSOC) dedicated exclusively to gender equality and advancement of women. It is the principal global policy-making body. Every year, representatives of Member States gather at United Nations Headquarters in New York to evaluate progress on gender equality, identify challenges, set global standards and formulate concrete policies to promote gender equality and advancement of women worldwide. This year it runs until 13 March.

Sir George Alleyne, UN Secretary-General Special Envoy for AIDS in the Caribbean.
Credit: UNAIDS

The United Nations Special Envoys for HIV/AIDS are individuals specially selected by the UN Secretary-General to help advance the AIDS agenda in the regions they cover. In a series of interviews, we explore their motivation and commitment to ensuring that AIDS is kept high as a political priority within their respective regions of responsibility and operation.

Sir George Alleyne was appointed by the UN Secretary-General in February 2003 to serve as his Special Envoy for AIDS in the Caribbean Region.

A national of Barbados, Dr Alleyne entered academic medicine in 1962, and his career included research in the Tropical Metabolism Research Unit for his Doctorate in Medicine. In 1990, Dr Alleyne was made Knight Bachelor by Queen Elizabeth II for his services to medicine and in 2001 he was awarded the Order of the Caribbean Community—the highest honour that can be conferred on a Caribbean citizen. From 1995 to 2003 he served as Director of the Pan-American Health Organization (PAHO).

Sir George, what motivates you to work on AIDS?

There was no single thing that first motivated me to work on the AIDS epidemic, no sudden epiphany. In the beginning, there were several factors: I had been concerned about AIDS when I was director of PAHO and I always had tremendous regard for Dr Peter Piot (the founding Executive Director of UNAIDS). Then the Secretary-General asked me to be his special envoy, and you don’t say no to the Secretary-General. It was only later that I realised the scale of what I’d taken on. An appreciation of the magnitude of the problem stimulates me to remain involved. HIV is one of the major health issues facing us.

What do you see as the role of a Special Envoy for AIDS?

It’s about getting access to the people who make decisions and exerting influence on them.

I have access to Prime Ministers and Ministers of Health and first I ask them to include AIDS in their public discourse. Second, I ask them to be seen publicly embracing people living with HIV. Third, I advocate for the inclusion of funding for HIV work in all ministerial budgets – not just at the Ministry of Health.

In Barbados there are now co-ordinators for HIV in every government ministry. The Prime Minister of Trinidad and Tobago convened a meeting of HIV co-ordinators to give him an account of what they are all doing in their ministries. It is a very healthy trend. I can’t claim to have achieved this alone, to do so would be arrogant and nothing in this area is done by one person. But what a special envoy can do is propose and advocate, but there are many factors and persons who exert influence to make sure something occurs.

What are the challenges facing the region?

In my view, the major challenge is getting the message across to politicians that preventing the spread of HIV is as important as HIV treatment and survival.

In general we are doing quite well in providing treatment to those who need it. However there is a danger of complacency about certain successes. For example mother-to-child-transmission (MTCT) of HIV is decreasing and the Caribbean has set a goal to eliminate MTCT in 2 to 3 years.

I’d like to see equal enthusiasm for HIV prevention. The time will come when it will be incredibly difficult to maintain treatment for an expanding number of people living with HIV. For all kinds of reasons, economic as well as human, it is important to spend more effort and a lot more time thinking about how to prevent people acquiring HIV.

The second main problem is the increasing incidence of HIV among young women. Many more young women are becoming infected than young men. It represents one of the more explicit manifestations of the power imbalance in our society – the inability of many women to negotiate whether they have sex, for example, and the economic disparities between the sexes.

Some years ago the Secretary-General said that education is a vaccine against HIV. It is true that in the Caribbean many of the younger girls who become infected have not reached the same educational level as their peers who are not infected. However, there are many more girls finishing high school and going to universities than boys, so education is not the only answer. The major answer lies in gender imbalance.

What do you think are possible solutions to this gender imbalance?

We are talking about something that is widespread and deeply ingrained. It is difficult to transform a societal problem with a single solution.

You can advocate about gender imbalance, expose it, discuss it and try to link up the groups working against it. You can encourage family-led education programmes in schools to be more explicit with boys and girls about their responsibilities.

You can encourage those who are like-minded to be more proactive in speaking out and encourage the kinds of educational approaches that will deal with it, for example in university gender studies.

Another solution is greater condom use and we strongly advocate this. When you talk to youngsters there is no doubt that lots of them engage in sex at an early age but some schools do not allow condom distribution. In some countries it is illegal to distribute condoms in prisons. So it’s not just about making people aware of condom use, but also establishing appropriate ways to make them accessible. These are very delicate issues. One hopes to work through channels that will allow not only debate but also acceptance.

How can you make a difference?

I’ve tried hard to play a constructive role in relations with faith-based organizations and I think I am getting somewhere. All the world’s great religions speak of inclusion rather than exclusion. My approach is to advocate a doctrine of inclusion – to think of people living with HIV as worthy of the same consideration as the rest of the flock. We enter into discussions of morality. Some groups are not enthusiastic about condom use but I argue that condoms are pro-life and not the other way round.

I also speak out openly against stigma and discrimination. For example, homophobia is very, very widespread in the Caribbean. People can be quick to assert that one should be more aggressive in the approach to politicians. But a politician who campaigns as specifically pro-homosexual would lose an election straight away in this region. So you have to look at how you can change public opinion to be less judgemental, how you can change perceptions.

This is not a moral issue – it’s about the rights of all people who are disadvantaged and discriminated against, including people living with HIV, men who have sex with men and sex workers.

Sex work has been with us since time immemorial and there are three things I would like to see change. Society should be such that men and women do not have to go into sex work to make a living. Secondly, if they do, we should make sure that they don’t have to run the risk of acquiring HIV. They need to be informed about the risks and be able to negotiate condom use, for example, be able to say to all clients: “no condom, no sex.” Thirdly, the state should provide opportunities for people who wish to stop sex work so that they can make a living in a less dangerous occupation. A woman recently told me: “If I could get another job less hazardous I would be happy to come out of sex work.”

A lot of the population close their eyes to the realities of things like this.

What is your proudest achievement as Special Envoy for HIV/AIDS?

I was very pleased to get the Caribbean Business Coalition against AIDS formed. It was something I promised the Secretary-General. Caribbean businesses have got together to see how business can respond to AIDS. For example, staff at a major bank in Guyana wear T-shirts once a week to promote HIV awareness, and businesses have been looking beyond philanthropy to outreach. One organization now provides confidential voluntary HIV testing and counselling facilities in its own establishment.

The Caribbean Association for Industry and Commerce has been a driving force in this, led by its energetic chief executive Ms Carol Ayoung and with the leadership of founding UNAIDS Executive Director Peter Piot. Karen Sealey, the current UNAIDS Regional Director for the Caribbean, has also been particularly strong at supporting this initiative.

Sir George, who or what inspires you?

The dedication, passion and enthusiasm of health workers is an inspiration. I was recently in Jamaica and met health workers setting up public information booths on street corners and chatting to passers-by about how to use condoms and protect themselves from HIV. Initially people were reluctant to engage with them but their professionalism was absolutely tremendous and people responded. You see this throughout the Caribbean.

I am also very inspired by the people I meet who are living with HIV. Their energy and commitment to improving the AIDS response on behalf of others makes you really want to be able to support them.

United Nations Economic and Social Council Special Event on Philanthropy and the Global Public Health Agenda, 23 February 2009.
Credit: UNAIDS

UN Secretary General Ban Ki-moon has called for “truly powerful global partnership for global health.” He was addressing over 400 executives and philanthropy leaders, representatives of UN Member States and other partners at the opening yesterday of a special event on Philanthropy at the United Nations Headquarters in New York.

“Just as I am striving to ensure that the United Nations delivers as one, so do I want all partners to come together to deliver as one in the field of global health,” he said.

The Special Event of the UN Economic and Social Council on Philanthropy and the Global Health Agenda was co-convened by UNAIDS and a wide range of partners and was a discussion of the ways to strengthen partnerships towards achieving the health-related Millennium Development Goals (MDGs), especially in areas where progress has been slow, for example maternal and child health, and which can benefit from stronger multi-stakeholder participation. Participants noted that the AIDS response is a useful exemplary model because it mobilizes a variety of partners, including governments, communities and the private sector around a common cause.

Improving health outcomes of women and girls

Dr Purnima Mane, Deputy Executive Director of UNFPA and former Director of Policy, Evidence and Partnerships at UNAIDS noted the importance of family planning, skilled care during childbirth and emergency obstetric care to protect maternal health. She also emphasized the importance of preventing mother-to-child transmission of HIV. Dr Mane stressed the importance of investing in MDG 4—to reduce infant mortality, and 5—to improve maternal health, while keeping up advocacy efforts on the other development goals.

There was consensus among panel members and participants on the need to strengthen the link between HIV and reproductive health in delivering care for women and girls. Progress in non-health areas for women and girls was seen as equally important including promotion of gender equality and access to education.

Gary Cohen, Executive Vice-President, Becton Dickinson (BD) described the role of corporate philanthropy in global health. He spoke of the “privilege” it is when a company offers its employees the opportunity to help others. During the past five years the company, which specializes in medical technologies, has also provided diagnostic tools and technologies for HIV. Through philanthropy outreach and community relations programmes, BD also supports immunization campaigns, promotes healthcare worker safety and raises awareness of pandemic diseases.

Neglected tropical diseases

Panel members and participants also agreed on the need to focus greater attention on neglected tropical diseases including a group of thirteen parasitic and bacterial infections that affect more than one billion people and kill 500,000 people annually.

Former US President Bill Clinton delivered the closing keynote address. President Clinton noted the timeliness of the special event during the current global economic crisis and the extraordinary need to focus on the effectiveness of public health interventions. He also highlighted the enormous contribution made by the AIDS response to AIDS in building networks for health and concluded that it is impossible to address global health without the active involvement of three key actors: governments, civil society and the private sector.

G. Kalyan, Secretary of Telugu Network for People living with HIV addressed the Andhra Pradesh Legislators Forum on AIDS on 21 February 2009.
Credit: UNAIDS

In a milestone in the political response to HIV in India, more than a 100 elected state legislators, from all major political parties in the south Indian state of Andhra Pradesh have pledged to incorporate the goal of universal access to HIV services in their political manifestos. Legislators from 15 major political parties in the state met at a special all-party function organized by the Legislators Forum on AIDS and the State AIDS Control Society on 21 February. They signed a joint declaration of intent to integrate HIV issues into their official electoral campaigning as they gear up for the state’s next election.

Andhra Pradesh is one of the states in India with a high prevalence of HIV and has some 53 million eligible voters. The state is slated to hold elections in four months time, all major political parties are currently preparing their political strategies and the gathering included members of the manifesto committees from all the major groups. The Forum’s aim is to keep HIV high in the political priorities, irrespective of whichever party comes to power in the state, and to sustain the momentum already generated.

“All political parties need to realize the importance of HIV prevention and need to incorporate points related to it in their manifestoes. We must go to the people with one voice. The political sector can influence the public and can awaken people at large,” said Dr. S. Shailajanath, the Convener of the Andhra Legislators Forum on AIDS.

The all-party pledge was preceded by several consultations and interactions between legislators and affected communities including sex workers and sexual minorities and signifies a major step forward in the political response.

“We think this is an important initiative. If political parties give priority to HIV issues then it will be a major opportunity to mainstream HIV and end the culture of silence that afflicts the epidemic,” said Kalyan Rao, Secretary, Telugu Network for People living with HIV. He said that such a show of political support will have a positive impact on reducing stigma and discrimination against the most-at-risk-populations.

The Project Director of the Andhra Pradesh State AIDS Control Society, Dr Chandravadan, stressed the significance of the political commitment to the AIDS response. “It’s the first initiative of this kind in the country and the representation from all political parties illustrates the commitment towards HIV issues.” Elaborating further, Rajeswara Rao of Telugu Desam Party said: “a special effort will be made to address the issue of children infected with or affected by HIV.” Similar pledges were also made by representatives of all political parties at the function in the State Assembly’s Central Hall.

B. Kamalakar Rao M.L.C. Co-Convener, APLFA, Congress Party Representative, addressed the Andhra Pradesh Legislators Forum on AIDS, 21 February 2009.
Credit: UNAIDS

The gathered legislators also received a toolkit on HIV designed for elected leaders and a detailed report card highlighting the gaps in achieving millennium development goals in the state. Prepared by UNICEF, the report card provides detailed information on the challenges and what they could do to achieve the targets.

UNAIDS provided technical support to the Andhra Pradesh Legislators Forum on AIDS, which was the driving force behind the pledge. It is one among 14 similar Legislators Forums in other states of India. The Parliamentary Forum on AIDS is now working towards building a similar political consensus on HIV at the national level as India heads into its 15th general election.

The site is a clearinghouse for the generation and sharing of authoritative information about the role of male circumcision in HIV prevention.
Credit: malecircumcision.org

A new web site on male circumcision for HIV prevention was launched today by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the AIDS Vaccine Advocacy Coalition (AVAC), and Family Health International (FHI).

The site — www.malecircumcision.org — is designed to be a clearinghouse for the generation and sharing of authoritative information about the role of male circumcision in HIV prevention. The information has been reviewed by technical experts from around the world and provides evidence-based guidance to support the delivery of safe male-circumcision services as one component in a comprehensive approach to HIV-prevention services.

“The Clearinghouse will be continually updated with emerging information on country progress in expanding access to safe male circumcision services, including lessons learned in implementation,” said Dr. Catherine Hankins, Chief Scientific Adviser to UNAIDS. “Providing access to tools and guidance, the Clearinghouse is an essential website aid for all those working on male circumcision for HIV prevention,” she added.

UNAIDS led the preparatory UN work plan on male circumcision and supports WHO as the lead for UN implementation support for the introduction or expansion of safe, voluntary male circumcision services. UNAIDS recommends that male circumcision always be considered as part of a comprehensive HIV prevention package. Key UNAIDS materials on male circumcision are included on the new web site.

“The Clearinghouse will serve as the ‘one-stop-shopping’ site for the most recent news, research, and resources on the use of male circumcision to prevent HIV, says Dr. Kim Eva Dickson, medical officer for HIV prevention in the health sector, WHO. “We want to attract the attention of the international public-health community—including scientists, civil-society groups, policy makers, health providers and programme managers.”

Resources include:

• A browsable database of hundreds of scientific abstracts and full-text articles
• An inventory of research activities on male circumcision
• Tools and guidelines for provider training and programme scale-up
• Evidence-based protocols and guidelines
• A compendium of better and best practices
• An opportunity to sign up for an RSS feed on news related to male circumcision
• A global mechanism for exchanging and integrating information on male circumcision programmes and associated services

“Circumcising men is among the most promising public health tools to reduce new HIV infections in areas most affected by the epidemic,” said Al Siemens, PhD, CEO of Family Health International.

“We are proud to have helped produce such a practical and evidence-based resource for health professionals interested in improving men’s access to high quality male circumcision services as a component of comprehensive HIV prevention efforts.”

(from left) UNAIDS Executive Director Michel Sidibé met John Tedstrom, President of the Global Business Coalition on AIDS, Tuberculosis and Malaria, 3 February 2009.
Credit: UNAIDS

On 3 February 2009, UNAIDS Executive Director Michel Sidibé met for the first time with John Tedstrom, President of the Global Business Coalition on AIDS, Tuberculosis and Malaria (GBC). At the meeting, Mr Sidibé explained his vision and priorities for UNAIDS and the business rationale for further engaging the private sector in scaling up universal access to HIV prevention, treatment, care and support. They also discussed some specific ways to strengthen the on-going partnership between UNAIDS and the GBC.

The meeting was followed by a telephone session with over 40 GBC companies from various industry sectors. These “GBC Connections” series are designed to provide GBC members with the opportunity to learn and discuss issues firsthand from thought leaders in the field of AIDS, Tuberculosis and Malaria.

During the phone conversations, Michel Sidibé encouraged companies to focus on five important issues: scale up prevention of mother to child transmission; increase efforts to control TB in people living with HIV; Push for preventive research; development of new medicines; and the establishment of effective advocacy platforms.

Mr Sidibé stressed the need to strengthen and expand existing industry-wide initiatives, to catalyze new public-private partnerships, and to grow more emphasis on UNAIDS country offices to start having closer partnerships with companies in the field. Michel Sidibé also made a strong and urgent appeal to all companies to mobilize human and financial resources for scaling up universal access to HIV prevention, treatment, care and support. GBC member companies showed interest in preventive research and in the focus on saving mothers and babies as one of the key and necessary steps to achieving universal access.

HIV and the workplace

Multinational companies as well as small and medium enterprises play a key role in the response to AIDS. As two out of three people living with HIV go to work each day, the workplace is one of the most effective settings for responding to the epidemic. Existing structures and facilities can be used for HIV prevention, care and support services, while corporate communication systems already in place are ideal for disseminating HIV information. Workplace programmes also help reach populations missed by the public health system (e.g. migrant workers) or can positively spread to the surrounding communities.

Workplace programmes can help ensure broad-based participation by workers as their involvement engenders ownership, less fear of discrimination, greater trust of prevention messages, and higher up-take of services such as testing and treatment.

UNAIDS and the private sector

UNAIDS is convinced the private sector has a vital role to play in the AIDS response and has contributed towards the establishment of over 30 national business coalitions on AIDS worldwide assisting with resources, technical assistance and national political leverage.

The Joint Programme has also built new partnerships across a variety of industry sectors such as the Sherpa pharmaceutical and diagnostic mechanism which fostered key commitments on the part of 17 companies (e.g. Abbott, Aspen, Gilead, GSK, Merck, Pfizer, Ranbaxy) to increase access to treatment, or the hotel Initiative in Mexico which brought over 40 hotels around an HIV prevention campaign and the implementation of long term HIV policies, etc.

For more information please contact Regina Castillo, Chief Private Sector Partnership, UNAIDS email: castillor@unaids.org or Marie Engel, Partnership Advisors email: engelm@unaids.org

The report, “Home Truths: Facing the Facts on Children, AIDS, and Poverty” calls for fundamental shifts in global, regional and national responses to the epidemic’s impact on children, their families and communities.
Credit: JLICA

The global response to AIDS must be significantly reoriented to address the unmet needs of millions of children and their families in the worst affected countries, according to a new report by the independent Joint Learning Initiative on Children and HIV/AIDS (JLICA).

The report, “Home Truths: Facing the Facts on Children, AIDS, and Poverty” summarizes two years of research and analysis of AIDS policies, programmes and funding and calls for fundamental shifts in global, regional and national responses to the epidemic’s impact on children, their families and communities.

"Families are at the heart of the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “Policies, programmes and funding must focus on providing universal access to HIV prevention, treatment, care and support for the family as a unit to ensure that both children and the adults who care for them get the essential services they need.”

The JLICA report outlines a clear and achievable action agenda to improve the scope and impact of services for children, their families and communities. Yet, experts point out that, while these JLICA-endorsed approaches are clearly supported by evidence and experience, setting a new direction for policy on children affected by HIV and AIDS will demand major shifts in both thinking and action.

Among the key recommendations highlighted in the report are the need to focus on children’s needs, not their orphan or HIV status when designing and implementing policies and programmes. More than 60% of children in southern Africa live in poverty. Singling out those directly affected by HIV is not only inefficient, but can also have undesirable effects -- such as stigmatization and abuse of those in need of help.

Health and social services, such as expanded access to HIV testing and treatment, should reach out to families as a whole. An effective response to AIDS requires the delivery of integrated, family-centred services in health, education and social welfare that are well-resourced and linked to communities.

The report also states that basic economic security can help families invest in children’s health and education, increase their use of available services, and pay for essentials such as food, medicine and transport to health facilities. Income transfer efforts, which place funds directly in the hands of families that need them, have demonstrated impressive results in improving child and family well-being in several African countries.

According to the report, urgent action is needed to address the social conditions and norms that render women and adolescent girls highly vulnerable to HIV infection. Therefore, the report calls for increased efforts to tackle behaviours and attitudes that protect or promote sexual abuse of women and girls.

JLICA is an independent alliance of researchers, implementers, policy-makers, activists and people living with HIV. JLICA partners and supporters include the Association François-Xavier Bagnoud – FXB International; Bernard van Leer Foundation; Bill & Melinda Gates Foundation; FXB Center for Health and Human Rights, Harvard University; Global Equity Initiative, Harvard University; Human Sciences Research Council, South Africa; Irish Aid; Netherlands Ministry of Foreign Affairs; UK Department for International Development; UNAIDS; and UNICEF, among many others.

This article first appeared in the official programme of the 23rd Teddy Award

23rd TEDDY Award, 59th Berlinale International Film Festival

Film offers invaluable insights into the lives of different cultures, groups, and people. It is a medium that has a long history in addressing controversial topics and issues. For men who have sex with men, cinema has been a powerful platform to highlight the challenges they face in society.

From the 1969 release of Midnight Cowboy through to the works of Rosa von Praunheim, social acceptance of the acknowledgement and openness about men who have sex with men has grown. Most recently, major Hollywood films such as Brokeback Mountain (2006) have brought further mainstream attention and acceptance. Undoubtedly, AIDS – and its impact on this community – has been one of the most powerful storylines used in the past two decades, especially as the men who have sex with men community continues to be one of the groups hardest hit by the epidemic. The landmark film Philadelphia (1993) has been widely used to change attitudes towards AIDS and men who have sex with men, as well as to evoke an upsurge of compassion.

Nearly three decades since AIDS was first recognized, much progress has been made globally to prevent new HIV infections and provide antiretroviral therapy to those who need it. But men who have sex with men continue to bear a substantial burden of HIV infection, with increasing numbers of new infections occurring in a number of countries worldwide.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) works closely with communities and organizations of men who have sex with men and promotes their leadership and participation in the global AIDS response. UNAIDS acts as a bridge builder, linking men who have sex with men and their organizations with governments, other civil society and international partners. UNAIDS’ role is to ensure commitment to the protection of the human rights of men who have sex with men, and support countries to put in place strategies and programmes to achieve universal access to HIV prevention, treatment, care and support.

Obstacles in responding to the sexual health needs of men who have sex with men

A significant hurdle in reaching out to men who have sex with men in a number of countries is the criminalization: few men who have sex with men come forward for fear of stigma, discrimination, and/or legal repercussions and this, in turn, impedes efforts to reach men who have sex with men, and their partners with HIV services, such as prevention, treatment, care and support. Within the diverse communities related to men who have sex with men are groups which are even more stigmatized, such as sex workers, men who are living with HIV, or transgender people, and their specific needs all require attention.

A recent report addressing HIV and men who have sex with men in a number of countries in Eastern Europe, the Caucasian Republics and Central Asia found that although most of the early cases of HIV in the region were diagnosed among men who have sex with men, this remains the least understood of the most-at-risk groups. Reasons include the reluctance of these men to be identified as such (even in a medical context), homosexual sex resulting in criminal prosecution in some countries, and, even the absence of criminal sanctions, stigmatization and physical violence.

In a survey conducted among men who have sex with men in Georgia in 2005, one quarter of those interviewed (25.7%) reported having faced social exclusion, discrimination and even violence by strangers, neighbours, family members and friends because of their sexual orientation. The survey revealed that 10% of all respondents had faced physical violence, with reports of beatings and two cases of rape, while other respondents reported social rejection and unfair dismissal from work.

The impact of violence against men who have sex with men has galvanized action in Latin America where Brazil and Mexico top the table of reported incidents. But this may be because rights groups there monitor the situation more closely than elsewhere in the continent.

UNAIDS encourages governments to “know their epidemic” and know how it affects men who have sex with men. Using this information, governments need to not only invest resources in supporting HIV prevention, treatment, care and support for men who have sex with men – tailored programmes that respond to their health needs – but also address the discrimination, violence and other barriers that stand in the way of accessing services.

Epidemic among men who have sex with men

Spanning a period of just 28 years since five gay men in the United States were the first identified with an unusual pattern of diseases later labeled AIDS, the epidemic has claimed the lives of more than 25 million people so far across the globe.

Sex between men occurs in every culture and society – though its extent and public acknowledgement vary from place to place – and is thought to account for between 5% and 10% of global HIV infections. It is the predominant mode of HIV transmission in many high-income countries and continues to be the population group most-at-risk of acquiring HIV within Western Europe. However, in countries reporting on access to HIV services by key population group, only around 40% of men who have sex with men have access to the HIV prevention and care services they need.

Regional trends

Sex between men is the most prominent mode of HIV transmission in nearly all Latin American countries, the United States, Canada and some Western European countries.

In both Canada and the United States, unprotected sex between men accounted for 40% of new HIV diagnoses in Canada in 2006 and 53% in the United States in 2005. The number of new HIV diagnoses attributed to unprotected sex between men has also increased sharply in recent years in Western Europe. In Germany, for example, the number of new HIV diagnoses among men who have sex with men rose by 96% between 2002 and 2006.

The urgency in Latin America is underlined by official reports on the state of the HIV epidemic in Colombia, Ecuador, Bolivia and Peru where sex between men is acknowledged as being the main source of new HIV infections.

In Asia, unprotected sex between men poses a significant but under-studied factor in the region’s HIV epidemics. In Bangkok, HIV prevalence among men who have sex with men went from 17% in 2003 to 28% in 2005. Male sex workers also face a particularly high risk of infection.

In Africa, several recent studies suggest that more attention is needed to better understand the role of HIV transmission among this population and that the proportion of the epidemic attributable to sex between men may be larger than hitherto thought, but there is still a great lack of information.

Looking ahead

Experience has shown that effective responses to HIV are those based on respect for human rights, and unimpeded access to HIV prevention, treatment, care and support. UNAIDS supports efforts to amend laws prohibiting sexual acts between consenting adults in private, enforce anti-discrimination legislation, provide legal aid services, and promote campaigns that address homophobia. These protections, alongside universal access to HIV prevention, treatment, care and support for men who have sex with men, will go a long way to turning the tide of the epidemic in many parts of the world.

Law, law enforcement practices, stigma and discrimination must be tackled as part of national AIDS responses as vulnerability to HIV infection is increased where men are either excluded from, or exclude themselves from, sexual health programmes and services out of fear. Gay, lesbian, bisexual and transgender communities must be – and have the right to be – empowered to participate equally in the social and political life of their communities and countries. These communities, who were the frontrunners in the early days of the AIDS response, are key partners today in the movement for universal access to HIV prevention, treatment, care and support.