By Leonard Okello
International head of HIV/Aids, ActionAid

I have received the very sad news of the sudden death of Ramesh Venkataraman, the former ActionAid Asia HIV and AIDS regional coordinator. Ramesh joined ActionAid in April 2007 till he resigned his post at the close of 2008. He passed away on 31 January due to an internal haemorrhage. He had been suffering from multiple illnesses.

Over the last two years that I have worked with Ramesh, he touched my heart and became literally like my younger brother. He had—and will continue to have—a special place in my heart. We shared in depth both official and personal challenges and opportunities.

Ramesh had a deep passion for his work and a special love for ActionAid. He always stood up for Human Rights and fought injustice straight on, but his health frustrated him more and more as the days passed by. He always told me how much he knew of his abilities, but was getting increasingly frustrated by his physical strength failing him. He feared to fail the team that he loved so much and had a sense of responsibility that often drove him to tears of pain and hope depending on the context.

Ramesh was immensely intelligent, and had super advocacy skills with a range of media, cameras, drama, information technology, and a rich humorous language, something that fate never allowed him to fully utilize.

When we last met together in Delhi, Ramesh informed me that he feared his body was giving up. He resigned about two weeks thereafter. We kept in touch on and off although the phone lines were often not really friendly. Last time Ramesh and I talked on phone briefly he was very hopeful following a knee surgery.

But like my mother often told me, when a patient gives you a lot of hope, then you know it is about time to prepare for the worst. Human life, she always told me, lives on hope and it is hope that must keep you going till you rest at the end.

There is something else I learnt from the comrades of the African National Congress (ANC) and at college in Uganda, during the anti-apartheid struggles. "Do not mourn, Comrades, Mobilize!" was the slogan that kept them moving during tough times.

I am seeking of each and every one of the global AIDS movements across the world, to use this time of reflection to mobilize even more to deal with HIV and improve our health.

Please keep the fire that Ramesh kept burning so that we can deliver on whatever he left behind not yet done. Let us complete the struggle for human rights as passionately as he would have loved too.

May his soul rest in eternal peace. Aluta Continua! Solidarity!!

Credit: OneLove campaign

“Talk, respect, protect”

OneLove is a regional campaign running in Southern Africa that aims to get people talking about the trend of having more than one sexual partner at a time. The overall goal is change this behaviour which is a factor in the transmission of HIV in the region.

Using mass media and social mobilisation to communicate its message, OneLove encourages people to discuss multiple partnerships and come to greater understanding of the risks involved in their lifestyle choice.

Multiple partnerships and concurrent relationships

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.

OneLove national campaign South Africa

The South Africa OneLove campaign was launched on 14 January. With outreach to 16 million South Africans, the prime-time TV drama series “Soul City” and the “Soul City” radio drama are key vehicles to get the message out to people across the country. UNAIDS is a partner of the Soul City Institute which aims to promote healthy lifestyle choices through mass media advocacy.

The OneLove theme is also being featured on radio talk shows, through TV and radio advertisements and a number of outreach events. Over a million information booklets will also be distributed in multiple languages.

The overall goal of the campaign is to reduce the number of new HIV infections in South Africa by 10% by 2011. This will contribute to the goal set by the South African National AIDS Council (SANAC), which aims to reduce the number of new HIV infections in South Africa by half in a couple of years.

“South Africa currently has the largest number of HIV positive people in the world with some 5.7 million people living with HIV in the country and HIV prevalence in adults—age 15 to 49—is 18%. Campaigns that inform people of the potential risks of their lifestyle empowers people to make informed decisions about their sexual behaviour,” said UNAIDS Country Coordinator Catherine Sozi.

Social networking to discuss sexual networks

As well as mobilizing traditional media, OneLove is also employing social networks to highlight the issue of sexual networks. The campaign features on a range of social networking and new media fora including video sharing site YouTube, the Flickr shared photo gallery, a Facebook page and Twitter feed.

Participation and sharing of ideas is at the core of the campaign. The OneLove official website (http://www.onelovesouthernafrica.org) hosts, in addition to lots of information resources and fact sheets, a weekly competition and blog. Everyone is invited to comment on articles, add their views on a discussion board and take the online polls.

The HIV epidemic in Southern Africa

The severity of the epidemic in southern Africa—nine countries in the region account for 35 per cent of all HIV infections in 2007—underscores the need for intensified and accelerated action towards universal access to HIV prevention, treatment, care and support.

OneLove signature tune performed at the community launch of the OneLove South Africa campaign in Ubuntu Kraal in Orlando West, Soweto on the 24 January 2009.
Credit: OneLove campaign

UNAIDS has identified HIV prevention as a particular priority and it highlights the importance of reducing HIV incidence through a combination of prevention approaches. Combination strategies include education and raising awareness in relation to delayed sexual debut, increased condom use, male circumcision and reduction in numbers of concurrent relationships. The OneLove campaign is an important vehicle for this.

Monitoring and Evaluation systems and activities are key to tracking what is being done in HIV prevention, treatment and care and whether these activities are making a difference.
Credit: globalhivmeinfo.org

Monitoring and Evaluation (M&E) systems and activities are key to tracking what is being done in the field of HIV prevention, treatment and care and whether these activities are making a difference. A new platform (www.globalhivmeinfo.org) now allows M&E professionals worldwide to access and share information about the AIDS epidemic and the response in a ‘one-stop-shop’.

The webportal includes an extensive and continuously growing number of documents and resources for download in a digital library, interactive calendars of events and training activities and news flashes. The users are able to quickly find information and tools by searching the portal or the digital library, or can tap the wealth of information available on M&E-related sites throughout the internet by using the portal’s external search engine.

Additional features of the portal are social bookmarking functions and automatic alerts and RSS feeds. It also provides mechanisms for communicating with other M&E professionals and its collaborative features enable users to create virtual teams and workspaces. “The webportal is a powerful ‘one-stop-shop’ for information and resources on the M&E of the AIDS epidemic and response. It is a way for M&E professionals to gain exposure to exciting new M&E information, as well as share their own work with the global M&E community,” said Deborah Rugg, UNAIDS Chief, Monitoring and Evaluation Division.

A collaborative effort

The M&E webportal is the product of collaboration among various international agencies that focus on M&E for HIV-related programs, and its purpose is to serve M&E professionals working in local, national, and global capacities. These include field officers placed in-country by international partner agencies; their country counterparts working in national, regional, and local government agencies and non-governmental organizations; staff located at headquarters of international partner agencies; and other practitioners interested in M&E of AIDS programs.

Towards strengthening the “Third One”

As a platform for information exchange within the M&E community working on AIDS with its many partners and actors, the webportal also contributes to strengthening the “Third One” - One agreed country-level Monitoring and Evaluation System - and to ensuring that monitoring and evaluation approaches are coordinated and are generating reliable and timely information on the epidemic and the response.

Dr Renu Chahil-Graf, Director, UNAIDS Regional Support Team for the Middle East and North Africa
Credit: UNAIDS

Across North Africa and the Middle East, UNAIDS estimates that 35,000 people acquired HIV in 2007, bringing to 380,000 the number of people living with HIV. An estimated 25,000 died of AIDS-related illness in the same year. Effectively coordinated HIV prevention, treatment, care and support strategies are vital to the reduction of these figures.

In order to get a clearer picture of the challenges to leading and coordinating an AIDS response in the Middle East and North Africa (MENA) regions, an assessment of the National AIDS Coordinating Authorities (NACA) in 16 countries was recently carried out by the UNAIDS Regional Support Team.

“Having insights into the strengths of their national responses helps country partners identify opportunities for improved coordination,” said Dr Renu Chahil-Graf, Director, UNAIDS Regional Support Team for the Middle East and North Africa.

“Equipped with this information, countries are better informed to make decisions leading to the shared goal of universal access to HIV treatment, prevention, care and support services for those in need,” she continued.

National AIDS Coordinating Authorities assessment

Ministers and High Level Government Officials from MENA countries
Credit: UNAIDS

The assessment looked at institutional structures, governance, relationships between coordinating bodies, capacity strengthening, harmonization and alignment and operational challenges and made a series of recommendations.

Based on the review, UNAIDS convened the first regional meeting on national AIDS coordination in collaboration with the Sultanate of Oman last month in Muscat.

More than 80 participants representing directors of national AIDS programmes, senior health and other government officials from the Sultanate of Oman, Algeria, Egypt, Iran, Jordan, Lebanon, Morocco, Palestine, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen took part in the three day meeting. Representatives of WHO, UNDP, UNFPA, World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria for HIV (Global Fund) also attended.

Bringing together Ministers of Health, Ministers for Youth and Sports as well as Ministers of Social Services, the interactions facilitated cross-sectoral approaches to moving the AIDS responses forward.

“Three Ones” principles

Across the globe everyone is agreed on the need to use valued resources more effectively. Coordinated and harmonized partnerships are key to making this happen. This has resulted in an agreed set of principles introduced by UNAIDS. These “Three Ones” are shaping international and national initiatives on AIDS.

Implementing the Three Ones nationally requires National AIDS Coordinating structures to be involved in the following areas:

1. Leading the development of prioritized National Strategic Plans;
2. Strengthening monitoring and evaluation systems that facilitate oversight and problem solving for the national programme;
3. Leading participatory reviews of the performance of stakeholders in harmonizing and aligning their support to the national programme.

"Sharing Experiences on the Three Ones Principle in Action in the Middle East and North Africa" was the theme of the three day meeting. In addition to reviewing the results of the assessment, country specific roadmaps for the coming year were developed.

H.E Hasna Barkat Daoud, Minister of Youth, Sports and Tourism, Djibouti (left) chairing a session with Mr Elie Aaraj, President of the Regional Network of AIDS NGOs in the Middle East and North Africa
Credit: UNAIDS

Countries in MENA received approximately US$ 431 million from the Global Fund over the last four years. Recommendations for the revitalization of the national AIDS response in MENA were discussed in several different sessions and working groups and were recapitulated in the closing ceremony.

The universal access goal

“We are all aware that we are far from having achieved the universal access goal to make HIV prevention, treatment and care accessible for all those in need by 2010,” said Jihane Tawilah, WHO Representative and Chairperson of the UNAIDS Theme Group in Oman.

“In 2007, an estimated total of 150,000 people living with HIV were in need of antiretroviral therapy in the region. Those who received the therapy were only six per cent of this number, which is considered the lowest coverage rate among the WHO regions globally,” she added.

The priority in the region is to apply effective preventive intervention strategies and to increase the antiretroviral therapy coverage, she said, adding: “This will require re-examining our policies and practice and redirecting accordingly our efforts and resources to where we can achieve our universal access targets.”

Dr Chahil-Graf also highlighted the need to raise awareness about AIDS among the sections of society not yet reached by HIV prevention information.

WHO and UNAIDS resource kit for writing Global Fund round 9 HIV proposals

The resource kit has been designed to focus on the essential points which are presented in a user friendly way. The information is structured in a way that echoes the development of a proposal.
Credit: www.who.int

As applicants prepare their proposals for the next round of HIV funding, Round 9, UNAIDS and WHO have jointly developed an online resource kit to provide guidance in planning and writing strong Global Fund proposals.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is a financial mechanism that provides grants in support of evidence-informed, technically sound and cost-effective programmes for the prevention and treatment, care and support of persons infected and directly affected by HIV, tuberculosis and malaria. By 1 December 2008, it had signed grant agreements worth US$ 10.2 billion for 579 grants in 137 countries around the world.

The aim of the fund is to direct money to areas of greatest need so that a real difference can be made in peoples’ lives. As a part of this process hundreds of pages of technical documentation on how to design programmes or write a grant proposal have been developed by a range of technical experts. The challenge for the country partners writing their proposals is sifting through these myriad long and complex guidelines.

To simplify this, the resource kit has been designed to focus on the essential points which are presented in a user friendly way. The information is structured in a way that echoes the development of a proposal. It is aimed to be a practical tool that country partners can use with ease.

People are already finding it useful. “In the jungle of technical guidance for writing proposals that’s out there, communicating the unique relevance of this tool is the biggest challenge. However, country teams across this region have already begun to benefit from this important resource.” said Geoff Manthey, UNAIDS Global Fund regional focal point, Asia Pacific Regional Support Team.

Compilation of guidance

The content of the resource kit is a compilation of existing guidance developed by different technical agencies including UNAIDS, UNFPA, UNICEF and the World Health Organization. In preparation of the kit, the team reviewed Global Fund feedback on previous proposals and identified recurring weakness areas so that the content of this kit could address these.

“This toolkit is the result of close collaboration between WHO, UNAIDS, and other UN and civil society partners,” said Mazuwa Banda, Medical Officer, World Health Organization.

“We hope that it is widely distributed and, most importantly, used; and we will continue to work together to improve it in response to feedback from its users.”

It includes a number of technical guidance notes on cross-cutting issues relevant in the design of any HIV programme. These include gender, human rights and law, sexual minorities and social change communication. A number of notes on health systems strengthening are also included as well as guidance on specific intervention areas including HIV prevention, treatment, care and support.

There are also a number of practical tools included on managing the proposal development process including a planning matrix and costing tool.

Know your epidemic

Country data is vital to knowing a country’s epidemic in order to design an effective response. Statistics on HIV interventions, links to latest epidemiological fact sheets and other useful country information are also included in the resource kit.

Finding support

In addition to sharing guidance, the online kit includes a “Finding support” section which gives direction to assistance offered through WHO and UNAIDS as well as useful contacts and a list of focal points. While the response to and coordination of technical support to countries should be first addressed at country level within the UN theme group, WHO and UNAIDS can offer support by facilitating the proposal development process and providing general or specific technical guidance, to ensure that the proposal is technically sound and meets the other requirements. UNAIDS has established “Technical Support Facilities” across the world that help match countries technical assistance needs with most well suited technical assistance in the form of individuals and/or companies.

UNAIDS and the Global Fund

Given the complementary strengths and shared commitment to the global AIDS response, Global Fund and UNAIDS collaborate to accelerate progress towards universal access to HIV treatment, prevention, care and support services.

By offering a range of support to country partners to help applicants prepare strong proposals for Global Fund resources UNAIDS, as the United Nations coordinating programme on HIV, also helps to make the resources of the Global Fund work. UNAIDS also supports the Global Fund in monitoring and evaluating the performance of its grantees through strengthening the capacity of principal recipients and sub-recipients to report on grant implementation.

This collaboration is leading to real results on the ground as Nancy Fee who works in Indonesia as UNAIDS Country Coordinator notes: “As Indonesia has seen, a successful application to the Global Fund results in a grant that can make a huge difference to a country’s AIDS response.”

“Given all the guidance that exists on the application process, a user-friendly web-based tool such as this one, structured to compliment proposal development, can enable a country to navigate the complexities of the process and develop a strong proposal,” she added.

By Rodrigo Pascal, UNAIDS Partnerships Officer

Allan Dunaway, Founder and President of Honduras National Association of people living with HIV.

It is indeed sad news to hear of the passing of Allan Dunaway who died in San Pedro de Sula, Honduras on 25 January 2009 at the age of 39.

Allan was one of the earliest AIDS activists in Latin America and he dedicated 18 years to supporting people living with HIV struggle for the right to treatment access in his country.

Allan and his beloved wife Rosa González were the first couple in Honduras to publicly declare that they were living with HIV. They were co-founders of Fundacion Llaves, which provides care and support for people living with HIV and Allan was the founding member and President for two consecutive periods of the Honduras National Association of people living with HIV. He was also the Chair of San Pedro de Sula National AIDS Forum.

The words of his wife Rosa resonate with my memories of Allan as being by nature a quiet person but who was determined to highlight important issues on behalf of others: “Allan never doubted that he had to give a face to AIDS; and he made it clear from the beginning days of his activism that he had a responsibility to speak for those who had no voice.” Allan was tireless in his efforts to make a difference. He reached out to local organizations and community groups building capacity and empowering them to organize events, marches and workshops. He also conducted workshops on managing funds and administration. He believed in the power of collaboration and worked hard to ensure that different organizations were informed of each other's activities and so strengthen the overall impact of their projects.

Allan was an assiduous advocate of human rights and worked closely with the National Commissioner for Human Rights to end discrimination against people living with HIV.

One of the proudest moments for Allan was to hear his 13-year-old daughter Keren deliver a breathtaking speech on behalf of young people living with HIV to thousands of delegates from around the globe at the opening of 2008 International AIDS Conference.

Allan also attended the High Level Meeting in New York in June 2008 when he and Rosa and a group of women living with HIV met with the UN Deputy Secretary-General.

Speaking of the loss, Richard Stern of Agua Buena Human Rights Association said: “Allan was a hero in a political struggle for human rights, but most of all he was a devoted husband and father. He will be sorely missed by all of us who worked with him for so many years.”

This is indeed a sad loss for Rosa and Keren. As a family, the Dunaways have been passionate advocates for universal access to care, support and treatment for those living with HIV, particularly in Latin America. I have no doubt Rosa and Keren by continuing their advocacy will keep Allan’s memory alive.

By Eric Sawyer, cofounder of ACT UP, Housing Works, Inc., & Health GAP, Inc.

Martin Delaney.

Last week we lost one of the true heroes in the response to AIDS. Martin Delaney, the founder and longtime Executive Director of the HIV advocacy/education organization Project Inform, died of liver cancer at his home near San Francisco on January 23, 2009. Marty Delaney was 63.

The world is truly a poorer place after the loss of Martin Delaney. Marty was on the front lines of the community’s response to AIDS from the very beginning of the epidemic. Marty was smart, sweet and quick to move to the side of social justice in any issue he confronted. His vision, energy and un-ending commitment contributed to the development of some of the first effective treatments for HIV opportunistic infections.

In 1985 Martin Delaney founded Project Inform, a national HIV treatment information, public policy and advocacy organization based in San Francisco. Marty created Project Inform because people living with HIV and their loved ones needed access to information to help save their lives; because people who were not infected needed information to stay that way; and because people who cared needed help organizing advocacy campaigns to push the government to find a sense of urgency and a new approach to finding treatments for HIV/AIDS.

Through his work at Project Inform Marty was one of the founders of the community-based HIV research movement and helped to ensure that HIV treatment education becoming widely available to patients, medical providers and anyone who cared worldwide.

He led in the movement to accelerate Food and Drug Administration approval of promising drugs and was a key player in the development of today’s widely used Accelerated Approval regulations and Parallel Track system for providing access to experimental drugs to seriously ill people prior to formal FDA approval.

Mr Delaney was a member of the National Institute of Allergy and Infectious Diseases (NIAID) AIDS Research Advisory Committee from 1991 to 1995, served on NIAID’s National Advisory Allergy and Infectious Disease Council from 1995 to 1998. On January 19 2009, Mr. Delaney received the NIAID Director’s Special Recognition Award for “extraordinary contributions to framing the HIV research agenda.”

In recent years, among many other activities, Mr Delaney led the Fair Pricing Coalition to improve access to HIV treatment, and advocated for an aggressive research agenda to find a cure for AIDS.

Of Marty’s passing, our mutual good friend Larry Kramer (ACT UP and GMHC Founder) said: “He was a great, great, great person. Every single treatment for AIDS is out there because of activists like Marty and Project Inform. I shall miss him very much. He was a dear friend and fellow fighter. He was a phenomenal leader, a brilliant strategist, and an indefatigable caretaker of us all.

For further information about Martin Delaney or Project Inform, please contact Ryan Clary at 415-558-8669 or rclary@projectinform.org.

There is no doubt in the minds of health experts and activists that the official figures hugely underestimate the numbers of MSM living with HIV and newly acquiring HIV infection in Ukraine and elsewhere in the Region. Credit: UNAIDS/S.Dragborg

Judging by the official statistics, cases of HIV infection amongst men who have sex with men (MSM) in Ukraine, as in much of Eastern Europe and Central Asia, are so rare as to seem scant cause for concern.

“No statistics means no problem,” says Zoryan Kis of the All-Ukrainian Network of PLHIV (People Living with HIV). “The fact that the official numbers are very low is a danger for our work because we know that the epidemic exists but it is hidden.”

But there is no doubt in the minds of health experts and activists that the official figures hugely underestimate the numbers of MSM living with HIV and newly acquiring HIV infection in Ukraine and elsewhere in the Region.

In the 20 years since the first case of HIV infection was detected in Ukraine, only 158 MSM have been officially registered as living with HIV in a country with a total population of some 46 million people.

According to the 2007 UNGASS country report Ukraine has the most severe HIV epidemic in Europe, with just over 1.6 percent of the adult population estimated to be living with HIV. In 2007, 17,687 people were reported as newly infected with HIV, up 10 percent from 2006. Among them, the official number of new cases amongst MSM was just 48.

Together with the high degree of stigma attached to MSM in Ukraine, something the country shares with other countries in Eastern Europe and central Asia, this understating of the problem has contributed to authorities’ reluctance to back campaigns of prevention among MSM, activists say.

Beyond the official statistics, there is considerable data on MSM which paints a different picture. Various organisations, including UNAIDS, WHO and the International HIV/AIDS Alliance in Ukraine estimated that in 2006 there were between 177,000 and 430,000 MSM in the Ukraine, of whom between 3 and 15 percent of live with HIV, which is several hundred times the figure reflected in the official studies.

Stigma and discrimination

Official HIV figures in Ukraine, as elsewhere in the region, are based on the results of voluntary HIV testing during which people should normally be asked why they have sought a test.

But in countries where MSM face widespread discrimination and where there is a high degree of stigma attached to male to male sex, there is understandable reluctance on the part of MSM to give the true reason.

“Most of MSM are not open. They would not go and say: ‘I have had sex with men’. They would say ‘I have had risky behaviour, I have been injecting drugs or even I have visited the dentist and I am worried,” says Kis.

And often officials do not press for answers. “I have been tested four or five times, but I have never been asked for my sexual orientation,” Kis adds.

According to the European Centre for the Epidemiological Monitoring of HIV/AIDS, only 1,828 cases of HIV infection in MSM have been officially reported between 2002 and 2006 years in the 15 former Soviet countries making up the World Health Organisation’s Eastern European health region.

Turkmenistan and Tajikistan, report none, while Azerbaijan has only 10 and Belarus 29. The highest number is reported by Russia; but its 1,245 cases over the 5 years compares with more than 38,000 in Britain and 11,000 in Germany in the same period, countries with smaller overall populations.

Prevention services for MSM have improved in the last few years, but they remain significantly inadequate to impact and sustain behavioural change and thus reduce HIV transmission among this group of men in Ukraine.
Credit: UNAIDS/P.Carrera

Ambitious goals

In 2006, Ukraine set ambitious national goals for scaling up towards universal access to HIV prevention, treatment, care and support for groups at high risk of HIV. However, HIV prevention activities in the Ukraine, as in most of the rest of the region, are carried out by NGOs with financial backing from international donors, mainly the Global Fund for AIDS, Malaria and Tuberculosis.

For example, a two-year project called “Men Who have Sex with Men: HIV/STI Prevention and Support” was implemented in Kiev by the AIDS Foundation East-West, the Gay Alliance NGO and Noah’s Ark-Red Cross Sweden, with financial support from the Elton John AIDS Foundation amongst others.

The International HIV/AIDS Alliance in Ukraine, which is co-holder of the Global Fund grants, is currently undertaking 14 projects aimed at HIV prevention among MSM. They include outreach services, provision of information and education around HIV and sexually transmitted infections (STIs), behavioural change communication, promotion of safer sex, condom and lubricants distribution, counselling and rapid-testing for HIV, testing and treatment of STI, self-help groups and anti-stigma trainings.

“The scale and scope of prevention services for MSM has improved in the last few years, but they remain significantly inadequate to impact and sustain behavioural change and thus reduce HIV transmission among this group of men in Ukraine,” says Dr. Ani Shakarishvili, UNAIDS Country Coordinator in Ukraine.

The situation is similar elsewhere in Eastern Europe and Central Asia. For example, there are no state-funded HIV prevention programmes for MSM in Russia.

“Governments everywhere are reluctant to spend money on sex workers, on drug users, but MSM comes at the top of the reluctance list. It is probably the last programmes that the governments will start,” says Roman Gailevich, UNAIDS Regional Programme adviser.

The new programme marks an encouraging change of stance by the government.
Credit: UNAIDS/S.Dragborg

For the first time

Under pressure from international donors and an increasingly vocal and better organised local MSM community, the Ukrainian Government recently agreed to include and set targets for HIV prevention and treatment for MSM as a priority in its National AIDS Programme for 2009-2013.

“This change stems from comprehensive surveys in the community which show the real role of MSM in the HIV epidemic in Ukraine,” says Anna Dovbakh, head of team: policy & programme development at the International HIV/AIDS Alliance in Ukraine.

“Since 2005, activists of the LGBT (Lesbian, Gay, Bisexual and Trans-sexual) community have become more active and professional in their HIV advocacy and response,” she adds.

Activists and health experts say that the new programme, which is currently before the Parliament, marks an encouraging change of stance by the government.

But the jury is out on what real difference it will make, not least because the money for HIV prevention will continue to come from the Global Fund and other donors.

“The lack of Governmental commitment to provide resources, support and services for MSM and to address the existing legal, financial and administrative barriers to service access for MSM indicates that the Government of Ukraine is still not fully prepared to address the HIV epidemic in MSM,” says Shakarishvili.

 Back to top

(from left) UNAIDS Executive Director Michel Sidibé and UN Secretary-General Ban Ki-moon, 22 January 2009.
Credit: UN

Michel Sidibé was sworn in as new Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) by Secretary-General Ban Ki-moon at UN Headquarters in New York yesterday. Mr Sidibé took up his post as head of UNAIDS and Under Secretary-General of the United Nations on 1 January.

After taking the oath of office, Mr Sidibé had the opportunity to share his vision for a re-energized global AIDS response with Mr Ban. Accelerating the work on universal access to HIV treatment, prevention, care and support is Mr Sidibé’s top priority for UNAIDS.

Secretary-General Ban Ki-moon stressed his readiness to support Mr. Sidibé, saying: "I want to assure you of my full support in your new role as Executive Director of UNAIDS. I have no doubt your decades of experience with UNICEF and UNAIDS, including in the field, will be an asset to the fight against HIV."

"I am deeply committed to the fight against HIV on a personal level. I have—and will continue—to speak publicly about the importance of making universal access to preventive treatment, care and support a reality by 2010," said Mr Ban.

Mr Sidibé took the oath of office from Secretary-General Ban Ki-moon, 22 January 2009. Credit: UN

The Secretary-General also encouraged Mr. Sidibé "to seek bold measures" to ensure that people, irrespective of their life choices, get access to services. "We must therefore continue efforts to eliminate stigma and discrimination against people living with HIV and uphold their rights—including their right to travel."

Credit: UN

Thanking the Secretary-General for his exceptional commitment to AIDS, Mr Sidibé asked for his continued leadership in addressing critical challenges and barriers, especially those in achieving universal access and pledged to fulfil the mandate given to him by the Secretary-General.

Sidibe described UNAIDS as an organization with a soul. "UNAIDS is committed to solid teamwork with the Cosponsoring agencies and other partners in order to connect the United Nations with people," said Mr Sidibé.

China announced in 2008 plans for an extensive programme to tackle sharply rising rates of HIV amongst men who have sex with men (MSM)
Credit: UNAIDS

China announced in 2008 plans for an extensive programme to tackle sharply rising rates of HIV amongst men who have sex with men (MSM), in the latest sign that the country may be starting to face up to a crisis which long seemed taboo.

Announcing the MSM campaign, the ministry of health said that risky sexual behaviour was the biggest single factor behind the spread of HIV in mainland China, excluding Hong Kong, and that men who had sex with men were now the group most likely to become infected with the virus. In China there are around 700,000 people living with HIV, and 11.1 percent of these are MSM.

“In the past between 1 and 3 percent of MSM on the mainland had HIV; Now it is anywhere from 2.5 to 6.5 percent”, Hao Yang, deputy chief of the ministry’s disease prevention and control bureau, was quoted as saying by the China Daily.

The campaign involved targeted prevention measures for the estimated 5-10 million- Chinese MSM, including stronger promotion of condom use, expanded coverage and quality of HIV prevention activities, increased access to voluntary HIV counselling and testing services, and improved access to treatment for sexually transmitted infections.

As a starting point for its new large-scale campaign to reduce HIV among MSM, China is aiming for some 21,000 MSM to be HIV-tested in order to be able to establish a clearer statistical baseline for the infection rate. This is the largest such study undertaken anywhere in the world and the first of its kind in Asia.

Its prevention effort will involve MSM community based organizations (CBOs) and civil society at all levels. Community-based organisations are carrying out AIDS awareness campaigns, VCT referrals, peer education, safer sex promotion and condom distribution; hot-lines are being run and internet chat rooms and websites used.

UNAIDS, the joint United Nations programme on HIV/AIDS, sees the empowering of MSM and other marginalized groups to protect themselves from HIV as one of the main elements of the global AIDS response.

"The Chinese government has made addressing HIV prevention among MSM a priority and that is something which UNAIDS welcomes," said Bernhard Schwartlander, UNAIDS Country Coordinator in China.

In most Asian countries MSM remains an uncomfortable subject: in many of them, sex between men is illegal and reports of harassment are frequent.
Credit: UNAIDS

But despite progress in China, a number of shortcomings remain, with stigma and discrimination still all too prevalent amongst the general population and even within the MSM community itself.

It is estimated that by late 2007, only 8 percent of MSM had been reached by comprehensive HIV prevention interventions. Furthermore, more than half of China's MSM have more than one sexual partner but only between 10 and 20 percent of them use condoms, according to health ministry estimates.

“It is critical that the government and the many MSM working groups find ways to improve their ability to work together in open and nondiscriminatory partnerships", said Schwartlander.

Largely ignored

Developments in China come amidst indications that governments elsewhere in the Asia-Pacific region are also becoming more willing to acknowledge an epidemic that many had previously largely ignored.

In most Asian countries MSM remains an uncomfortable subject: in many of them, sex between men is illegal and reports of harassment are frequent. As a result, there has been little in the way of specific support for programmes for MSM.

“A lot of attention is being drummed up, but a lot more needs to happen,” said Paul Causey, a Bangkok-based consultant working with the Asia Pacific Coalition on Male Sexual Health (APCOM) and the United Nations on MSM-related issues.

Most Asian men who have sex with other men are not open about their sexual behaviour. Social taboos and discrimination mean that many opt to disguise their sexual preferences; for many others, their sexual practices with other men may only be a small part of social roles they play or their sexual lives. Given that many men who have sex with men also have sex with women, high HIV rates among MSM can also translate into substantial numbers of women at risk of exposure to HIV.

The combination of high numbers of partners with high-risk behaviour such as unprotected anal intercourse has been a key factor behind the accelerating HIV infection rate in many Asian cities.

It said that hardly any Asian country is devoting significant resources to MSM, despite the fact that prevention costs a lot less than treatment. According to the commission, $1 invested in effective prevention can save up to $8 in treatment expenditure for expanding epidemic countries.

Most Asian men who have sex with other men are not open about their sexual behaviour. Social taboos and discrimination mean that many opt to disguise their sexual preferences.
Credit: UNAIDS

Engaging community groups

The tipping point in awakening to the dimension of the MSM crisis was the convening of a special conference in New Delhi in September 2006 entitled “Risks and Responsibilities: Male Sexual Health and HIV in Asia and Pacific”.

The conference was truly tripartite, bringing together governments, donors and 380 members of community groups. As important as the event itself was the run-up, with 16 countries holding UNAIDS-sponsored preparatory meetings. In some cases, including that of China, it was virtually the first time that government officials and representatives from the wider MSM community groups met to assess the situation and discuss solutions.

One of the other lasting achievements of that conference was the decision to launch APCOM, which brings together civil society groups, government sector representatives, donors, technical experts and the United Nations to push for an effective response to the rising HIV incidence amongst MSM.

Its efforts complement those of a United Nations technical working group on MSM and HIV/AIDS in China launched in mid-2006. The group is led by the United Nations Development Programme (UNDP).

“The technical working group is working with government, MSM community groups and donors to improve co-ordination and communication, build government capacities to involve civil society organisations (CSOs) in policy-making and public service delivery, and develop the institutional and professional capacities of CSOs,” said Edmund Settle, HIV manager for UNDP in China.