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.

UNAIDS Executive Director Mr Michel Sidibé addressed the audience of the 23rd edition of the TEDDY Award in Berlin on 13 February.
Credit: UNAIDS

UNAIDS Executive Director Mr Michel Sidibé addressed the audience of the 23rd edition of the TEDDY Award in Berlin on 13 February with a strong message: universal access to HIV prevention, treatment, care and support must be accessible to all people who are in need—including men who have sex with men and other populations most-at-risk of HIV infection.

UNAIDS partnered with the organizers of the TEDDY Award to focus this year’s Teddy Topic on homophobia, human rights and AIDS.

The TEDDY Award is one of the longest running (since 1987) and most-respected international film awards for the lesbian, gay, bisexual and transgender (LGBT) community. The award is part of the annual Berlin International Film Festival commonly know as the Berlinale, which ended on 15 February.

At the start of the evening ceremony, Mr Sidibé engaged in a lively conversation with Dirk Ludigs, a well-known German journalist and author, outlining the work of UNAIDS and its partners in addressing the global AIDS epidemic.

Mr Sidibé stressed that countries can and should actively promote tolerance and inclusion, as well as confront homophobia and gender violence.

On the issue of human rights violations against sexual minorities, Mr Sidibé stressed that laws criminalizing sex between men drive the HIV epidemic underground, increasing the isolation of gays, bisexuals and transgender people and making them more reluctant to come forward to access HIV services.

Currently, 84 countries in the world have legislation that prohibits same sex behaviour. In the 2006 Political Declaration on HIV/AIDS, governments committed to removing these legal barriers and passing laws to protect vulnerable populations. 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.

Mr Sidibé’s messages were fitting as many of the LGBT-themed films at this year’s Berlinale concentrated on stigma and discrimination, the impact of AIDS as well as other challenges LGBT face in society.

Mr Sidibé said UNAIDS will continue to place human rights at the centre of its agenda and protect and support the rights of the LGBT community.

Other special guests at this year’s TEDDY Award included the mayor of Berlin, Mr Klaus Wowereit, the Ambassador of Mali in Germany, Ms Fatoumata Sire Diakite, British actress Tilda Swinton, American actor Joe Dallesandro, Dr Gottfried Langenstein, the president of ARTE (the French-German public broadcaster), and several German politicians. The host of the ceremony was Annette Gerlach, head of culture at ARTE.

In addition to the Teddy Award ceremony, Mr Sidibé met with the German Minister for Health, Ms Ulla Schmidt, the Minister for Economic Cooperation and Development, Ms Heidemarie Wieczorek-Zeul, several delegates from the German Federal Parliament, and representatives of the Berliner AIDS-Hilfe and the Deutsche AIDS-Hilfe, two NGOs engaged in HIV advocacy and policy in Berlin and Germany, respectively.

Click on the image to start video

(front row from left) Professor Miriam Were, Excellency Mr Joaquim Chissano, His Excellency Mr Festus G. Mogae and Ms. Joyce Mhaville. (back row from left) Dr. Innocent Ntaganira (WHO AFRO), Mr Ndolamb Ngokwey (UN Resident Coordinator in Mozambique), Dr. Kereng Masupu (Champions Secretartiat), Dr. Antonica Hembe (SADC), Mr Luke Nkinsi (Melinda and Bill Gates Foundation), Mr Mauricio Cysne (UNAIDS) and Paula Mondlana (Africa Forum)
Credit: UNAIDS/Doug Johnson

The “Champions for an HIV-free Generation” - an organization of African leaders including former African presidents and other influential personalities – visited Mozambique as part of their mandate to mobilize leadership in Africa and to promote effective policies and action on HIV prevention.

The aim of the visit was to advocate for keeping AIDS high on the political agenda in Mozambique as well as to step up efforts to prevent the spread of HIV in the country. As outspoken opinion-leaders, the Champions sought to initiate a dialogue in changing behavioural and societal norms.

“The Champions realize that stronger, more visionary leadership must come from within the continent most affected by this epidemic. We are here to reach our peers, our African brothers and sisters, to find solutions together,” said His Excellency Mr Festus Mogae, former president of Botswana.

Led by Mr. Mogae, the Champions met with Mozambique’s President Armando Guebuza, Prime Minister Luisa Diogo and several cabinet members, as well as with leaders of civil society organizations, development partners and the media. Through their discussions, the Champions shared regional experiences in fighting the disease and urged the scale-up of effective HIV prevention strategies.

Other Champions taking part in the visit included His Excellency, Mr. Joaquim Chissano, former President of the Republic of Mozambique; Professor Miriam Were, chairperson of the Kenya National AIDS Control Council; and Ms. Joyce Mhaville, chairperson of the Steering Committee of the African Broadcast Media Partnership Against HIV/AIDS (ABMP).

(from left) Excellency Mr Joaquim Chissano, Professor Miriam Were, Ms. Joyce Mhaville, (seated) His Excellency Mr Festus G. Mogae
Credits: UNAIDS/Doug Johnson

"The Champions for a HIV Free Generation is an extraordinary initiative. The Champions play a pivotal role in advocating for the scale up of key prevention activities that can have the greatest impact such as multiple concurrent partnerships and male circumcision," said UNAIDS Country Coordinator Mauricio Cysne.

Male circumcision

One of the priority issues that the Champions brought to Mozambique is the subject of male circumcision. The Champions asked the government to consider the rapid scale-up of male circumcision as a priority under the country’s current comprehensive HIV prevention plan. The Champions pointed out the compelling scientific evidence, globally and even locally, that male circumcision can reduce HIV infections greatly.

Furthermore, they also stressed the fact that male circumcision should always be considered as part of a comprehensive HIV prevention package and that the communication strategies around male circumcision are critical to prevent men from developing a false sense of security and engage in high-risk behaviours that could undermine the partial protection provided by male circumcision.

Multiple partnerships and concurrent relationships

Multiple partnerships and concurrent relationships were other issues brought forward by the Champions. In Mozambique, as in other parts of the southern Africa region, many people have more than one sexual partner. Close sexual networks are formed when men and women have multiple sexual partners or concurrent relationships—ongoing relationships with more than one intimate partner overlapping for weeks, months or years. If someone in this network acquires HIV it increases the chance of everyone else who is part of this network becoming infected.

(from left) His Excellency Mr Joaquim Chissano, Professor Miriam Were, Ms. Joyce Mhaville and His Excellency Mr Festus G. Mogae
Credits: UNAIDS/Doug Johnson

The Champions emphasized the importance of developing a nation-wide campaign to reduce multiple concurrent partners and to demonstrate strong leadership and engagement of prominent persons seen as role models. These recommendations come shortly after a new national HIV prevention strategy has been approved by the Mozambican government, and the Champions advocated for keeping the momentum for addressing issues of sexual behaviours that can increase the risk of HIV infection.

Social transformation

A social transformation of gender roles and relations is already under way in Mozambique, which can be seen from the recent legal changes. The Legislation on the Protection of People Living with HIV Against Stigma and Discrimination was promulgated in January 2009 and a new Domestic Violence Bill is underway which will improve women’s ability to negotiate sex and to prevent HIV infection. The Champions stressed that the government should fully support the development and implementation of these new legal mechanisms.

Finally the Champions pointed out the necessity for sustainable funding of the AIDS response and offered to share successful experiences from other countries in the region on effective allocation of resources and private/public partnerships.

More than 1.6 million people are estimated to be living with HIV in Mozambique. The disease, which disproportionately affects women and children, is estimated to claim more than 92,000 lives each year. Among the main drivers of the epidemic in Mozambique are large numbers of multiple and concurrent partnerships, low levels of circumcision and gender inequality.

Background on the Champions

The Champions for an HIV-Free Generation are highly visibly leaders and outspoken advocates for those affected and infected by HIV. Led by H. E. Mr. Mogae as chairperson, the founding members include four former African presidents, a Nobel Laureate, and other high-level African leaders from different walks of life. The Champions focus their efforts in sub-Saharan Africa, home to more than two-thirds of all people living with HIV. With a focus on proven HIV prevention practices, the Champions embrace and promote key policy, legal, cultural and behavioral practices and messages that help accelerate the social outcomes needed to achieve an HIV-free generation.

The collaborating partners of this initiative are the World Bank, UNAIDS, the World Health Organization, the Bill and Melinda Gates Foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and PEPFAR.

UNAIDS Executive Director Michel Sidibé addressed a public meeting attended by members of local AIDS organizations, community organizations, civil society, as well as diplomatic and government officials. The South African Minister of Health Ms Barbara Hogan also addressed the meeting.
Credit: UNAIDS/G. Williams 

This morning the Executive Director of UNAIDS, Mr Michel Sidibé gave his first major global statement at a public meeting in Khayelitsha, a township on the outskirts of Cape Town in South Africa which has a population of approximately half a million people.

Building on the commitment countries have made to reach universal access by 2010, Mr Sidibé set out his strategy for the future direction of UNAIDS and highlighted the need to invigorate global momentum, action and commitment towards achieving universal access to HIV prevention, treatment, care and support.

Like other regions of the world southern Africa is feeling the effects of the global economic crisis. Mr Sidibé stressed the need for follow through on domestic and international investments and commitments to meet 2010 country targets.

Khayelitsha is home to around half a million people.
Credit: UNAIDS/G. Williams

"We cannot let the economic crisis paralyze us,” said Mr Sidibé. “Stimulus packages and economic adjustments should be made with a human face in mind. A mother should not have to choose between continuing AIDS treatment and feeding her children. We cannot let down the 4 million people on treatment and millions more in need today.”

Members of local AIDS organizations, community organizations, civil society, as well as diplomatic and government officials were among the guests and the South African Minister of Health Ms Barbara Hogan also addressed the public meeting.

A new report released by UNAIDS today, “What countries need: Investments needed for 2010 targets”, calls for investment to ensure countries reach the ambitious universal access targets that they have set for 2010. To reach these, an estimated investment of US$ 25 billion will be required in 2010 which is US$ 11.3 billion more than is available today.

“It will not be easy to close this gap but it is achievable and absolutely necessary if we are to accelerate the pace of the response to the AIDS epidemic,” said Michel Sidibé. “Together we will help save lives—by putting more people on treatment, protecting babies and young people from getting infected, and ensuring that a whole generation of children will graduate from school.”

The Ubuntu Clinic in Khayelitsha treats tuberculosis and HIV
Credit: UNAIDS/G. Williams

The public meeting took place at the Ubuntu Clinic which treats tuberculosis (TB) and HIV. With a TB/HIV co-infection rate of around 70 % in Khayelitsha, this clinic allows patients to register for both TB and antiretroviral treatments. Given that TB accounts for an estimated 13% of AIDS deaths worldwide, it’s vital to ensure that people living with HIV have access to TB prevention, diagnosis and treatment. The Ubuntu Clinic’s model of "service integration" has since spread to other clinics across the township. The Ubuntu Clinic ran the first programme on the prevention of mother-to-child transmission in South Africa and has provided antiretroviral treatment to approximately 20,000 people.

This afternoon Mr Sidibé flies to Johannesburg where he will hold a series of meetings with civil society and Foundation representatives as well as meet United Nations staff. This is the first official country visit Mr Sidibe has undertaken in his new role as Executive Director of UNAIDS.

“What countries need: Investments needed for 2010 targets”

A new report released by UNAIDS, "What countries need: Investments needed for 2010 targets," estimates that an investment of US$ 25 billion will be required for the global AIDS response in 2010 for low- and middle-income countries—US$ 11.3 billion more than is available today.

“It will not be easy to close this gap but it is achievable and absolutely necessary if we are to accelerate the pace of the response to the AIDS epidemic,” said UNAIDS Executive Director Michel Sidibé.

The investment needs is based on the country-defined targets to reach universal access to HIV prevention, treatment care and support by 2010. The new report anticipates that nearly one third of this investment will come from domestic sources, with investments from multilateral and bilateral sources needed for the remaining US$ 17 billion.

The report highlights that, of the total investments required, approximately one third is for activities addressing behavioural change, social drivers of the epidemic, social mitigation and other services that are managed outside of the health sector through multisectoral programmes.

Another one third is aimed at strengthening health systems. The weakness of health systems is a major obstacle to scaling up to universal access to prevention, treatment, care and support.

The remaining one third will go towards HIV specific health services, such as programmes to reduce mother-to-child HIV transmission, blood safety, and provision of antiretroviral therapy for those in need.

HIV prevention, treatment and care

It is estimated that nearly US$ 11.6 billion will be required for HIV prevention and US$ 7 billion for treatment.

The priority HIV prevention services chosen by countries are based on UNAIDS prevention guidelines, which call on countries to prioritize programmes according to the type of national epidemic. For example, countries with generalized epidemics have an urgent need to scale up prevention services for young people. Whereas countries with concentrated epidemics are advised to focus first on providing services and programmes to the most-at-risk populations, including sex workers, their clients, injecting drug users, and men who have sex with men.

The investments needs for treatment and care cover more than the provision of antiretroviral treatment. Besides including costs for antiretroviral treatment, they also include provider initiated testing and counseling, treatment and prophylaxis for opportunistic infections, nutritional support, laboratory testing, palliative care and the cost of drug-supply logistics. The costs for CD4 testing to monitor the response to antiretroviral therapy and disease progression are also included.

What can be achieved with the $25 billion?

With the achievement of country-defined targets of HIV-related services, in 2010 approximately 6.7 million individuals would be receiving antiretroviral treatment. More than 70 million pregnant women will be screened and receive prevention of mother-to-child transmission services; 20 million men who have sex with men, 7 million sex workers and 10 million people who inject drugs will receive HIV prevention services. Seven million orphans will be supported and nearly 8.1 billion condoms (male and female) distributed. This will result in averting 2.6 million new HIV infections, cutting HIV incidence by nearly 50% and averting 1.3 million deaths.

Achieving country-defined targets by 2010 presents an opportunity to change the pace of the response to the AIDS epidemic. It will help save lives—by putting more people on treatment, protecting babies and young people from getting infected, and ensuring that a whole generation of orphans will graduate from school. It will also build the foundation for sustaining the AIDS response for years to come, as well as contributing to the strengthening of health systems and increasing human resources. It will help reduce homophobia, stigma and discrimination, especially of the voiceless and marginalized. It will contribute to reducing violence against women and girls and empowering millions to protect themselves from HIV and sexual abuse.

It is clear that in today’s financial climate, investments must be made wisely. But the human face must be kept in mind; behind each reduction or cutback is an individual, a family.

“We cannot let the economic crisis paralyze us,” said Mr Sidibé. “Stimulus packages and economic adjustments should be made with a human face in mind. A mother should not have to choose between continuing AIDS treatment and feeding her children. We cannot let down the 4 million people on treatment and millions more in need today.”

As the report concludes, universal access has to become a reality for the hundreds of millions of people who are vulnerable to HIV infection and the millions of people living with HIV and their loved ones. Investments already made in responses to AIDS are showing results. This is a time for scaling up, not scaling down.

UNAIDS Executive Director Michel Sidibé (left) met with the Deputy Speaker of Parliament Mrs Nozizwe Madlala-Routledge on 9 February 2009 in Capetown.
Credit: UNAIDS/G. Williams

The Executive Director of UNAIDS, Mr Michel Sidibé, is visiting South Africa where he will announce plans for the future direction of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

This morning in Cape Town he met with the Deputy Speaker of Parliament Mrs Nozizwe Madlala-Routledge.

Tomorrow he will outline his strategy for the future direction of UNAIDS during a speech in the South African township of Khayelitsha where he will be joined by the Minister of Health Hon. Ms Barbara Hogan.

Building on the commitment countries have made to reach universal access by 2010, Mr Sidibé will set out his strategy and highlight the need to invigorate global momentum, action and commitment towards achieving universal access to HIV prevention, treatment, care and support.

He will also outline the investments needed for countries to reach their targets for 2010.

This is the first official country visit Mr Sidibe has undertaken in his new role as Executive Director of UNAIDS.

South Africa currently has the largest number of people living with HIV in the world—approximately 5.7 million and HIV prevalence in adults aged 15 to 49 is 18%.