(from left) Ambassador Louis Charles Viossat; Tim Martineau, UNAIDS Director of the Technical and Operational Support Division.
Credit: UNAIDS/Mamadou Gomis

Assessing what really works in the AIDS response, and understanding how it works, is all the more pressing in the current context of global financial slowdown said experts at an ICASA session on Friday.

"The current economic downturn leads us to redouble our efforts and look carefully at the effectiveness of programmes and whether or not they are delivering the results we want," stressed Tim Martineau, UNAIDS Director of the Technical and Operational Support Division.

The event, “Public private partnerships against HIV: how can we together turn the tide?” was organized by UNAIDS as part of the conference’s Leadership Programme. Ambassador Louis Charles Viossat chaired a discussion with panelists who included representatives from the Nigerian Business Coalition Against AIDS, Versteergard Frandsen, the Cameroon Business Coalition against AIDS and the United Nations Economic Commission for Africa.

The event explored the benefits and challenges of public-private partnerships in the global response to AIDS.

A public-private partnership (PPP) is defined as an “institutional relationship between the state and the private profit and/or the private non-profit sector, where the different public and private actors jointly participate in defining the objectives, methods and implementation of an agreement of cooperation”. They are characterized by the sharing of common objectives, as well as risks and rewards.

For governments, PPPs can be an opportunity to harness experience in areas where they lack expertise, as well logistical efficiencies that enable better delivery of prevention and treatment services, reducing costs.

For the private sector (profit and non-profit), PPPs may mean a gain in business opportunities, and an enhanced social and economic environment to operate in.

Participants were agreed that attention should be paid to ensure wide participation and representation across the private sector including from the labour unions, employers’ federations, small and medium enterprises and the informal sector. While progress has been seen, there is still a lot to do to improve participation by small and medium enterprises and the informal sector which employ most of the labour force in Africa.

The group identified four factors as critical in creating and sustaining successful PPPs:

• Clear definition of partners’ roles and responsibilities
• Transparency and respect for ethical standards
• Coordination between partners
• Periodic assessments of the partnership

For Ambassador Louis Charles Viossat, "public-private partnerships have proved to be effective and a way forward to better respond to AIDS. However, we need to acknowledge that they are not a silver bullet.”

“Training, information, periodic assessment of the partnership and application of ethical standards are all important," he continued.

Innovation was stressed as a key factor for any public-private partnership to be successful. Navneet Garg, Global Business Manager from Danish company Versteergard Frandsen, "The Millennium Development Goals (MDGs) of stopping the transmission of HIV by 2015 can only be met by using innovative approaches which facilitate rapid scale-up targeting one and all.  Public and private partners should utilize their respective strengths and enhance their partnership accordingly. The enormous challenge needs both partners to step up to achieve what is needed to meet the MDGs".

From Cape Town to Lagos, several new studies are starting to provide a better understanding of men who have sex with men (MSM) within the context of HIV in Africa.

“Homosexuality is very much understudied in West Africa, and in Nigeria it is criminalized, making it difficult to reach MSM,” said Sylvia Adebajo, a researcher at the University of Lagos, Nigeria. “As a result, the lives of MSM are characterized by denial, violence, and stigmatization”.

Ms Adebajo was speaking at an ICASA session held yesterday on men who have sex with men and HIV infection in Africa. She said that a significant hurdle in reaching out to MSM in Africa, and in particular in West Africa, is criminalization; few MSM come forward for fear of stigma, discrimination, and legal repercussions.

At this forum researchers presented several findings, some preliminary, that shared similar conclusions: HIV prevalence for MSM is many times higher than ‘background populations’, few self-identified MSM seek medical support or identify themselves in their communities, startling numbers do not wear condoms when having sex, many engage in bisexual behaviour, and few get tested to know their HIV status.

“Many MSM when they finally had a HIV test and it was positive, had not known their status and had continued to engage in high-risk behaviour for some time,” said researcher Earl Ryan Burrell of the Desmond Tutu HIV Foundation. “HIV programmes in South Africa are heavily heterosexual and female focused… more recognition of MSM as a risk group is needed,” he added. His ongoing study in Cape Town and its surrounding townships showed that many MSM are not aware of the risks associated with certain sexual acts, despite self-identifying as MSM and having varying levels of access to HIV prevention information.

A study completed in 2006 in Nigeria revealed that little is known about the link between HIV prevalence and MSM in the country. But of those surveyed nearly all reported having multiple concurrent partnerships with both male and female sexual partners. Condom use was low and when condoms were worn, many men used saliva or soap or oil-based lubricants, such as domestic cooking oil which can damage the surface of  condom.

The researchers ended the session by encouraging African governments to invest more resources in supporting HIV prevention and, most importantly, to recognize MSM as a group that requires tailored programmes. “More is needed to be known. Each of these communities have their unique prevention and treatment needs,” said Ms Adebajo.

Ms Souadou N'Doye, a young Senegalese, urged those attending ICASA to ensure that young people are involved in the design of HIV programmes. Credit: UNAIDS/Jacky D. Ly

ICASA 2008 closed on 7 December with a strong message: youth are essential in the response to AIDS in Africa, especially those living with HIV. The closing ceremony began with a statement delivered by Ms Souadou N'Doye, a young Senegalese. She spoke on behalf of all young Africans and urged those in attendance to ensure that young people are involved in the design of HIV programmes.

She asked governments and partners to utilize the talents of young people from each country. Without young people, she stressed the AIDS response is incomplete. "All that is done for us, but without us, is against us," she said.

Professor Souleymane M'Boup, president of the ICASA 2008 organizing committee, expressed his gratitude to the organizers and to participants who travelled from all over the world to attend the Africa-focus AIDS conference. He emphasized his satisfaction in knowing that all people touched by HIV were present at the conference and had a platform to express their concerns, from vulnerable women and sex workers to men who have sex with men and migrants. He said the mosaic of participants made this 15th edition of ICASA a success. Most importantly, Prof M’Boup said he realized over the past five days that “Africa is moving, and that energy and hope are everywhere.” He closed by asking participants to return home with one message – Africa’s AIDS response must be advanced.

The need for a focus on sexual minorities, the greater involvement of youth, religious and military leaders and the urgency to improve HIV prevention programmes have been running themes throughout the conference sessions. A cross-cutting issue was the need for long-term financing. This was identified as a critical aspect for human development in Africa and especially for an effective and sustainable response to AIDS.

The closing ceremony of ICASA 2008, Dakar, 7 December 2008. Credit: UNAIDS/Jacky D. Ly

The ICASA organizers used the closing ceremony to deliver a series of awards to those leaders active in addressing AIDS. UNAIDS Executive Director Dr Peter Piot, Dr Michel Kazatchkine, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, and Dr Meskerem Grunitzky-Bekele, Director of the UNAIDS Regional Support Team for West and Central Africa, were among those who were presented with an award from the Senegalese Minister of Health and Prevention, Dr Safiatou Thiam.

(from left) Sylvie Bertrand, UNODC Regional Programme Coordinator HIV and AIDS in Prison Settings - Southern Africa; Dr Johnson Byabashaija, Commissioner General Uganda Prisons Service
Credit: UNAIDS/Mamadou Gomis

“If we do not implement adequate measures to prevent HIV infection in prisons, people incarcerated will always be vulnerable to the disease,” said Mr Gallo Diop, a former prisoner and AIDS advocate from Senegal.

Mr Diop was speaking on Friday 5 December at an ICASA session organized by the United Nations Office on Drugs and Crime (UNODC) titled “HIV and AIDS prevention, care, treatment and support in prison settings”.

He emphasized that the movement of people in and out of prisons is also contributing to the spread the virus among those outside of prison settings.

Session participants analyzed the impact that HIV is having inside African prisons and there was consensus that addressing HIV situation in prisons is a key component of effective responses to AIDS.

Overcrowded prisons with poor facilities and sanitary conditions combined with a lack of HIV prevention services, health care and adequate nutrition are contributing to the spread of the virus argued participants. They identified the need for more data and research to identify the nature and patterns of risky behaviours.

Brian Tkachuk, the United Nations Office on Drugs and Crime (UNODC) Regional Advisor for HIV and AIDS in prisons - Africa
Credit: UNAIDS/Mamadou Gomis

“There is still a knowledge gap in understanding the magnitude of the epidemic in African prisons and its multiplier effect on the non-prison population in the region,” said Brian Tkachuk, the United Nations Office on Drugs and Crime (UNODC) Africa Regional Advisor for HIV and AIDS in prisons during his presentation.

In order to mitigate the impact of HIV in prisons, Mr Tkachuk highlighted the need to raise awareness of HIV among prisoners, promote peer education and provide access to prevention interventions like availability of condoms, safe tattooing and injecting equipment, and access to private visits with partners. He also underscored the need to provide access to HIV treatment and adequate nutrition for prisoners living with HIV.

Mr Tkachuk noted that “the HIV situation in prisons remains a highly neglected area that needs immediate attention,” and he called for the adding of HIV in prisons into National AIDS responses.

“You can never succeed in addressing the AIDS situation in prisons if you don’t have total political commitment,” said Dr Johnson Byabashaija, Commissioner General Uganda prisons Service. At the same time, he emphasized, there is a need to establish strong information management systems to collect qualitative data for the development of focused advocacy and HIV prevention programmes for prison settings.

At the Centre de Santé Roi Baudouin, Dr Piot and Princess Mathilde met with staff who shared an overview of the health centre’s services. Dakar, 6 December 2008.
Credit: UNAIDS/Jacky D. Ly

While in Senegal attending ICASA 2008, UNAIDS Executive Director Dr Peter Piot and UNAIDS and UNICEF Special Representative HRH Princess Mathilde of Belgium spent 6 December learning firsthand the successes and challenges faced in Dakar in providing HIV prevention and treatment services, in particular for women, children and young people.

In partnership with UNICEF, the Government of Belgium, and UNAIDS’ regional office for West and Central Africa and its Senegal office, UNAIDS and UNICEF jointly visited health centres supported by UNICEF where they met with health officials, medical practitioners, community mobilizers, and people living with HIV.

Centre de Santé Roi Baudouin

Located in Guédiawaye, on the outskirts of Dakar, this district centre is a main provider of gynaecology, obstetric, and paediatric services, and receives support on maternal and child health from UNICEF.
Credit: UNAIDS/Jacky D. Ly

At the Centre de Santé Roi Baudouin, Dr Piot and Princess Mathilde met with staff who shared an overview of the health centre’s services and chatted with patients and their families. Located in Guédiawaye, on the outskirts of Dakar, this district centre is a main provider of gynaecology, obstetric, and paediatric services, and receives support on maternal and child health from UNICEF. It also provides antiretroviral treatment for more than 300 people living with HIV. Voluntary counselling and testing services are offered as well as services for the prevention of mother-to-child transmission of HIV. With tuberculosis a leading cause of death for people living with HIV in sub-Saharan Africa, the Roi Baudouin centre provides treatment to address TB/HIV co-infection.

Centre Conseil pour Adolescents – an open environment

The second visit of Dr Piot and Princess Mathilde was to the nearby Centre Conseil pour Adolescents (CCA). The CCA serves as an important access point to reach out to young people with a range of HIV prevention, care and support services. The centre has a working relationship with the health centre ensuring that young people who are in need of treatment have access to it.

The CCA provides treatment for other sexually transmitted infections. As a drop-in youth centre with a strong recreational component, the CCA is an open environment where young people feel comfortable getting information about sex and reproductive health without fearing stigma or judgement. The CCA in Guédiawaye was the first of its kind in Senegal and there are now 13 others like it throughout the country.

Self-sufficiency

Dr Piot and Princess Mathilde ended their joint UNAIDS and UNICEF visit at the Centre Régional du Recherche de Formation within the Centre Hospitalier Universitaire de Fann – a research and training institution that has a long tradition in the country. Since 2007, the centre has provided HIV treatment to more than 3,500 people in need.

Self-sufficiency is a distinguishing feature of the centre. It has a vegetable garden where fresh food is grown to help boost patients’ nutritional needs. Through its national, regional and international networks, the centre shares and receives information regarding HIV and other sexually transmitted infections. Dr Piot and Princess Mathilde were briefed on an upcoming virtual health library project hopes to expand on-line to reach more people.

Credit: UNAIDS/Mamadou Gomis

Opinions on sexuality and condom use vary depending on the different beliefs of religious and traditional leaders in Africa. Nonetheless, today at ICASA there was general agreement that regardless of an individual’s choices, human beings should be treated equally and with respect.

“We cannot fight AIDS if part of the population is marginalized,” said panelist Fatima Ball. “We have to take care of everybody but especially the most vulnerable”.

Religious and traditional leaders reflected on their roles and responsibilities in the response to the HIV on Friday in a session moderated by UNAIDS Director of Partnerships and External Relations Mr Elhadj Amadou Sy. The session took the form of a debate, where the audience posed questions to the panel.

Recognizing a shared commitment to the AIDS response, it was underlined at the session that religious and traditional leaders have norms and values that can either contribute effectively to the response or can become inhibiting factors.

The session was moderated by UNAIDS Director of Partnerships and External Relations Mr Elhadj Amadou Sy
Credit: UNAIDS/Mamadou Gomis

Religious leaders often have high expectations placed upon them by their local communities. As a result, they may be charged with reaching out to communities and addressing a complex range of social behaviours and attitudes. Although religious leaders are often best placed to address these aspects, many expressed that they do not have sufficient levels of support to perform their roles.

Equipping traditional leaders with knowledge of HIV and how it is transmitted, and strengthening their skills, was seen as an important way forward.

UNAIDS and UNICEF Special Representative HRH Princess Mathilde of Belgium. Credit: UNAIDS/Mamadou Gomis

Participants in a series of ICASA sessions on youth leadership and Africa’s AIDS response were in clear and unanimous agreement: young people are vital to preventing new HIV infections and moving towards the goal of an AIDS-free generation.

UNAIDS and UNICEF Special Representative HRH Princess Mathilde of Belgium was one of those who reconfirmed her commitment to youth and HIV issues. Attending ICASA 2008 this week, today she participated in two sessions on heightening the engagement of young Africans’ in the AIDS response.

Princess Mathilde and UNAIDS Executive Director Dr Peter Piot opened the first session on youth leadership, which was moderated by UNAIDS Special Representative Gaetano Kagwa, a Ugandan national and well-known AIDS advocate. They were joined by representatives of youth non-governmental organizations from Cameroon, Botswana, Senegal, and Zambia.

(from left): HRH Princess Mathilde of Belgium; Dr Pape Salif Sow, Head of the infectious diseases, Fann University teaching hospital, Dakar; Dr Peter Piot UNAIDS Executive Director
Credit: UNAIDS/Mamadou Gomis

Dr Piot introduced Princess Mathilde and commended her for her engagement and activism with AIDS and young people.
During her opening remarks, Princess Mathilde shared three points that can be instrumental in an improved response to AIDS in Africa: young people need to be more engaged and included in HIV programmes; leaders must provide youth with platforms to be heard; and young people themselves have to step forward and serve as examples in their communities and to share knowledge about HIV prevention. Princess Mathilde concluded by calling on girls and young women to be active participants in the AIDS response.

At an afternoon session, “Intergenerational dialogue: Where are the young leaders in the African response to AIDS?” Dr Piot and Princess Mathilde were joined by other leaders and representatives from several African youth organizations.
With a strong presence of young people in the audience, the panellists expressed their optimism for Africa’s next generation but outlined the challenges that lie ahead in terms of confronting the impact of AIDS on young people – one of the groups most affected by HIV.

Throughout the day’s sessions, participants stressed the need to better address HIV and young people given that young people remain at the centre of the AIDS epidemic in terms of increasing rates of infection, vulnerability, impact, and – most importantly – potential for change.

Globally, an estimated 5.5 million of the 33 million living with HIV are young people aged 15-24 years and about 45% of new HIV infections in 2007 were among 15 to 24 year olds.

Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria
Credit: UNAIDS/Jacky Daniel Ly

Sustainable investment in health is crucial for African countries’ successful development stressed Dr Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, TB and Malaria.

“The world has finally understood that health is a priority for development and not a consequence of development,” said Dr Kazatchkine. “Investments in health have an impact and have saved lots of lives”.

Dr Kazatchkine was speaking at the 15th International Conference on AIDS and STIs in Africa (ICASA) where he highlighted the need for a long-term approach to the reinforcement of health systems in sub-Saharan Africa.

Financial resources for AIDS have increased significantly in the last five years because donors and the international community recognize how health can be a key investment in development. Dr Kazatchkine said that this investment coupled with an unprecedented mobilization of civil society has been showing results.

However sustainability is crucial argued Dr Kazatchkine. More predictable resources for countries generate the necessary environment that would allow countries to design programmes with the confidence that they will be sustainable. “If money is made available to countries, more programmes would be implemented and therefore the investment on AIDS would generate better results,” said Dr Kazatchkine.

UNAIDS Executive Director Dr Peter Piot and HRH Princess Matilde of Belgium co-chaired the plenary
Credit: UNAIDS/Jacky Daniel Ly

Dr Kazatchkine also stressed that addressing the challenges of weak health systems is critical. “Donors have contributed to strengthening health systems all over the world but more resources are required to address the health systems challenges such as infrastructures, facilities or health workers,” said Kazatchkine.

Finally, he added that there is a need for more than resources. The promotion of evidence-based responses that reach out to those most in need, human rights, strengthened social protection and strengthened global and local partnerships are responsibilities shared by countries and the international community.

UNAIDS Executive Director Dr Peter Piot and HRH Princess Matilde of Belgium co-chaired the plenary which was held on Friday.

Workplace leaders pledge action at ICASA 2008
Credit: ILO

On the occasion of the 15th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), about fifty workplace leaders gathered together on 4 December at the invitation of the International Labour Organization (ILO).

Earlier in the week, the delegates had visited the Workplace Leaders Pledge Centre and committed themselves to implementing specific initiatives to address HIV in their own workplaces once they return home from the conference.

The ILO recorded the workplace pledges of the participants and invited them to join Mr. Mamadou Sow, the Permanent Secretary of the Ministry of Labour of Senegal, Mr. Assane Diop, the ILO Executive director for Social Protection, Mr. Patrick Obath and Mr. Lamine Fall representing respectively the employers and workers organizations as well as Dr. Sophia Kisting, Director of the ILO Programme on HIV/AIDS and the world of work for the group photo.

“Many ICASA delegates are HIV experts in various fields and probably spoke about HIV/AIDS in a number of forums. However, some might not have thought of taking HIV activities into their own workplace,” explained Dr. Kisting.

Each participant who made a pledge received a gift as a reminder of his or her commitment. The ILO ‘Workplace Leaders Pledge Centre’ will welcome participants until the end of the Conference. It is situated at the ILO stand in the exhibition area next to the UNAIDS stand with other co-sponsors.

Ms. Evelyn Serima, ILO HIV/AIDS Technical Specialist with the ILO Sub-regional Office for Southern Africa, explained that the pledges received demonstrate the commitment of employers and workers to contribute to a more sustained response to HIV/AIDS through workplace leadership.

UNAIDS and ILO Joint Satellite Session, 3 December 2008
Credit: UNAIDS

A consensus is emerging at ICASA that in countries across Africa the private sector needs to work more closely together in order to be successful in responding to AIDS.

According to Sophia Kisting, Director of ILO-AIDS speaking at a UNAIDS ILO session yesterday, "The different private sector actors—companies, small and medium enterprises, informal sector—have to work together towards delivering a coherent and comprehensive private sector response to AIDS. We owe that much to those who are affected by the epidemic."

The joint Satellite Session entitled “working towards a comprehensive private sector response at the national level.” It was an opportunity for participants shared what’s working and what needs to be improved in their countries.

Strengthening partnerships across the private sector, reaching out to the surrounding community as well as mobilizing financial and technical resources for HIV were the issues addressed by the delegates.

For this discussion members of the Ghana Business Coalition on AIDS, Federation of Kenyan Employers, Malawi Congress of Trade Unions, Rio Tinto, Standard Bank Africa joined representatives from the International Organization of Employers, ILO, Fondation Sogebank, World Bank, UNAIDS Technical Support Facilities, Partners Against AIDS, GTZ, and the Global Business Coalition on HIV/AIDS, TB and Malaria.

Strengthening partnerships, reaching out to the community

Aldiouma Cissokho addresses the event
Credit: UNAIDS

In Zimbabwe where the Employers’ Confederation, the National Business Coalition and others have created a national forum on the private sector to ensure one voice of the private sector at the Global Fund Coordinating Country Mechanisms.

Another challenge expressed was that have strong leadership. Mr Patrick Obath, Chairman of the Federation of Kenyan Employers, shared their efforts to encourage CEOs to get tested for HIV as a way of generating more support for voluntary testing and counselling within their own companies.

Rio Tinto’s Health Director Mr. Bruno Buclez presented the partnership agreement they have signed with the Government of Cameroon whereby the government is supplying free drugs and the company is making its health facilities available to its employees and to the community. One of the concerns raised about such Public Private Partnerships is their sustainability. This is something Rio Tinto is assessing at the moment. For example, the company is trying to ensure that employees living with HIV who retire from the company continue to receive HIV treatment.

Mr. Tony VanderNest, Senior Health and Wellness, Standard Bank Africa, South Africa explained that his company supports national business coalitions and the Pan African Business Coalition (through notably personnel secondment) because these coalitions are the best vehicle to share experiences among companies.

Mobilizing financial and technical resources for HIV and AIDS.

Ms. Thérèse Lethu, Director from the GBC Europe showcased how the coalition is encouraging sectoral initiatives such as in the tourism and mining industries to optimize the impact of the private sector on the national systems is the primary goal of the GBC.

All participants also agreed that the role of small and medium enterprises should be enhanced. As Erick Maville, Technical Director, GBC Europe explained, "While progress has been made to enhance the contributions of the private sector to the response to AIDS, there is still a lot to do to enhance the participation of small and medium enterprises and the informal sector."