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."

As 5000 delegates from across Africa and the world gather in Dakar this week, condoms are being made freely available for delegates in hotels in the city as part of a HIV prevention drive.

The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) and UNAIDS have teamed up with the Senegal Hotel Industry around an HIV awareness initiative.

The 15th International Conference on AIDS and STIs in Africa which runs until Sunday this week has drawn aapproximately 5000 delegates and several hundred journalists from all over the world to Dakar. The event presents an opportunity to engage the local hotel industry on issues related to HIV. The hotel industry is a key player in the response to AIDS as it reaches a wide and diverse audience, including employees, with HIV prevention information.

A kit has been distributed in all hotels which includes condoms provided by the United Nations Population Fund (UNFPA); a flyer to present the initiative; and a copy of a short prevention film directed by Accor and Air France for broadcast in hotel rooms or lobbies.

Partnering hotels

The 18 ICASA-accredited hotels were approached to voluntarily take part and they have the option to customize the content according to their specific needs. Additional hotels in Dakar are also free to join.

Two fold initiative

As well as a specific HIV prevention campaign during ICASA, the initiative also will develop an HIV action plan over the long term. This will focus on delivering workshops for senior management (such as hotel managers and human resource managers) to help participating hotels develop a practical plan to respond to AIDS in their own organization.

Training sessions for staff will also be developed and will focus on the risks of HIV in the hotel industry. These sessions will help them understand their respective roles in the practical implementation of an HIV action plan within their organization. UNAIDS is providing seed money for the initial trainings.

Technical Partners

Three local non-governmental organizations ENDA Tiers Monde/Santé, Sida Services and ACI Senegal are the technical partners for the implementation of the training process and the follow up with hotels. These NGOs will conduct an initial mapping of the HIV vulnerability of each hotel. The analysis will be conducted with the participation of hotel personnel.

Background

This is a continuation of the HIV awareness initiative by UNAIDS and the hotel industry during the International AIDS Conference held in Mexico City in August 2008 which reached out to over 5000 employees within 50 hotels.

It’s also part of a global HIV prevention campaign conducted by the GBC within their tourism and travel platform: disseminating HIV awareness videos in airport lounges and on TVs via TV5 Monde, developing a prevention campaign online with a fun quiz on the website of Europe Assistance, conducting voluntary counselling and testing mobile clinics at the Sofitel Terenga, Novotel and Club Med Cap Skirring.

Next steps

On 2 December, a meeting took place at the Sofitel Dakar with 6 hotel managers to gather their suggestions and define the scope of the project and the roadmap. The analysis of hotels’ specific needs, as well as the workshops and training sessions will start after ICASA and spread over 2009.

(from left) First Lady of Mali, Madame Lobbo Traore Toure; Minister of Women, Senegal, Madame Awa Ndiaye; UNAIDS Deputy Executive Director Mr Michel Sidibé. Dakar, 4 December 2008. Credit: UNAIDS/Mamadou Gomis

Stigma towards people living with HIV as well as the need to halt the spread of the disease were the main themes discussed by a gathering of First Ladies of Africa which took place earlier today in Dakar. Their panel discussion on the HIV response was moderated by Mr Michel Sidibé, UNAIDS Deputy Executive Director.

On the occasion of the 15th International Conference on AIDS and STIs in Africa (ICASA) taking place in Dakar this week, high-level delegates, civil society representatives and technical experts from across Africa and elsewhere are gathering for discussions under the theme “Africa’s Response: Face the facts.”

UNAIDS Deputy Executive Director Mr Michel Sidibé speaks with Princess Lalla Salma of Marocco before the First Ladies of Africa event. Dakar, 4 December 2008. Credit: UNAIDS/Mamadou Gomis

Madame Lobbo Traore Toure, First Lady of Mali; Madame Jeannette Kagame, First Lady of Rwanda and Her Royal Highness, Princess Lalla Salma of Morocco participated in this afternoon’s event.

Thanking them for their presence and for their long-term personal engagement in the AIDS response, UNAIDS Deputy Executive Director Michel Sidibé spoke of how their commitment has enabled the creation of dialogue and political action around the issue of stigma and HIV prevention.

“As mothers, spouses and concerned citizens, you, First Ladies of Africa, have decided to take leadership on AIDS, speaking out against stigma and against violence against women and girls and advocating for the protection and rights of people living with HIV,” said Mr Sidibé.

At the meeting the panelists spoke of the importance of HIV prevention programmes and brought into focus priorities including the care of orphans and vulnerable children, preventing mother-to-child HIV transmission and access to paediatric treatment. The panellists also discussed how resources could be better mobilized for HIV programmes at country level.

UNAIDS Deputy Executive Director Mr Michel Sidibé. Dakar, 4 December 2008. Credit: UNAIDS/Mamadou Gomis

The First Ladies shared their experiences of the HIV response through regional organizations such as the Organization of African First Ladies Against AIDS (OAFLA) and Synergies Africaines, as well as in their own countries through national organizations. The meeting was a chance to exchange perspectives and enhance collaboration in west Africa.

In 2007 the OAFLA launched the “Save the Unborn Child First Ladies Campaign” in the 50 OAFLA member countries. This campaign focuses on the prevention of HIV transmission from mother to child. The prevention of new infections among young people, and protection of children affected by HIV from stigma were the aims of the “Treat every child as your own" campaign launched by OAFLA in 2005.

Yesterday during the conference opening ceremony, Princess Lalla Salma, spouse of King Mohammed VI of Morocco, received the prize of the 15th ICASA 2008 in recognition of her commitment to the fight against AIDS. The prize was presented by ICASA's chairman, Professor Soulaymane Mboup.

Dr Piot traced the history of the AIDS epidemic in Africa over the past quarter century and highlighted some key milestones in the response during a plenary session at ICASA on Thursday. Credit: UNAIDS/Mamadou Gomis

“We can not predict the future but we can certainly influence it,” said UNAIDS Executive Director Dr Piot looking ahead after his review of the past 25 years of AIDS in Africa. Dr Piot traced the history of the AIDS epidemic in Africa over the past quarter century and highlighted some key milestones in the response during a plenary session at ICASA on Thursday.

His presentation illustrated the history of AIDS from the explosive growth of the first AIDS cases in central Africa to an epidemic of well over 20 million people across the continent, and Africa’s main cause of death.

During his speech, Dr Piot underlined how emerging political leadership and civil society activism have helped to remove the silence and denial that surrounded the epidemic in the 1980s and early 90s. In some African countries, this has helped mobilize high level political commitment that is now producing results such as fewer people becoming newly infected with HIV and fewer people dying.

Dr Piot also recalled some key meetings and events, such as the Abuja Declaration on HIV in 2001; the creation of the Drug Access Initiative, and the launch of Africa’s first national AIDS treatment programme (in Botswana). He also covered some of the continent’s impressive scientific contributions to the global AIDS effort. Among these are the discoveries of HIV-2 and SIV, genetic heterogeneity of HIV, mechanisms and prevention of heterosexual and perinatal transmission, the use of cotrimoxazole to treat and prevent opportunistic infections, male circumcision.

Members of the audience for Dr Piot’s presentation Credit: UNAIDS/Mamadou Gomis

As well as reviewing progress so far, the presentation looked at some of the many challenges that lie ahead. These include sustaining political commitment and funding, expanding coverage of access to antiretroviral treatment, intensifying HIV prevention, increasing technical and community capacity, and connecting the AIDS response with other public health and development efforts. Above all, Dr Piot underscored the need to know the local modes of HIV transmission in order to better tailor prevention measures/programmes.

Last week UNAIDS launched a new report calling on countries to realign HIV prevention programmes through understanding how the most recent HIV infections were transmitted, and understanding the reasons why they occurred.

“Not only will this approach help prevent the next 1,000 infections in each community, but it will also make money for AIDS work more effectively and help put forward a long term and sustainable AIDS response,” said UNAIDS Executive Director Dr Peter Piot.

Finally, Dr Piot emphasized the need to maintain an exceptional response to AIDS, not only as a short term emergency but as a long-term event that requires broad partnerships, leadership and commitment. “We can not predict the future but we can certainly influence it,” said Dr Piot.

“West Africa HIV/AIDS epidemiology and response synthesis”

On the opening day of International Conference on AIDS and STIs in Africa (ICASA), taking place in Senegal under the theme “Africa’s Response: Face the facts,” the World Bank launched a new report exploring the character of the HIV epidemics and responses in countries in West Africa.

The “West Africa HIV/AIDS epidemiology and response synthesis” is a review and analysis of surveillance and research data in 15 West African countries: Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone.

Aiming to gain an improved understanding of HIV transmission dynamics in this sub-region, the paper focuses on the degree to which epidemics in each country are concentrated or generalized, and the implications that this has for effective prevention strategies. The report argues that more prevention focus is needed on the specific groups in which HIV transmission is concentrated, including female sex workers and men who have sex with men.

The new publication highlights a need for better understanding of the complex nature of transactional sex in West Africa. Many women involved in commercial sex do not self-identify as sex workers and have other occupations as well. The boundaries between commercial and non-commercial sex are blurred and it is difficult to have an idea of the proportion of men having commercial sex due to substantial under-reporting.

The importance of men who have sex with men (MSM) in the HIV epidemic in West Africa is being increasingly recognized. High proportions of MSM are also married and/or have sex with other women with very low rates of condom use, acting as a bridge for HIV between MSM and women.

“Know your epidemic. Know your response”

The paper was written as part of the work programme by the World Bank’s Global AIDS Monitoring and Evaluation Team (GAMET) to support countries to “know your epidemic, know your response” so that interventions are carefully chosen and prioritized based on a careful characterization of each country’s epidemic.

Understanding the behaviors that are giving rise to most new infections is a crucial first step to being able to develop a results-focused, evidence-based response that will be effective in preventing new infections. In turn this will improve resource allocation, all the more appropriate when global economic outlook may impact AIDS response.

The work was carried out in partnership between the World Bank and UNAIDS and with the collaboration of the National AIDS Councils and AIDS programmes of the countries.

On the opening day of ICASA 2008, a new regional report is launched by UNAIDS Executive Director Dr Peter Piot that looks at the vulnerability of women and girls in Southern Africa to HIV.

Dr Peter Piot addresses the launch of the UNAIDS RST report on vulnerability of women and girls in Southern Africa.
Credit: UNAIDS/Jacky D. Ly

Almost two-thirds of all young people with HIV live in sub-Saharan Africa where about 75% of all infections among young people aged 15 to 24 years are among young women.

Responding to the need to understand why young women and girls living in countries in this region are so vulnerable to HIV infection, UNAIDS and the Reproductive Health and HIV Research Unit of the University of Witwatersrand in South Africa convened an expert technical meeting in June 2008.

The meeting agreed four specific sets of actions at community and country levels that are grounded in national strategies and are context specific. The four key actions are:

1. Mobilize communities for HIV prevention, with strong male involvement, to design relevant strategies and messages about the causes, consequences of and solutions to young women and girls’ vulnerability
2. Expand access to high quality, well-integrated essential sexual and reproductive health and prevention services, while mobilising demand for and use of them.
3. Develop and ensure adequate technical and financial resources for implementation of national strategies that address the structural drivers of vulnerability.
4. Strengthen country capacities for epidemiological and behavioural surveillance, priority research, and monitoring coverage and impact of prevention responses to generate information to improve decision-making.

“UNAIDS Technical Meeting on Young Women in HIV Hyper-endemic countries of Southern Africa” was launched on the opening day of ICASA 2008, Dakar.

Participants at the meeting included regional researchers; representatives of national AIDS councils, government departments and the Southern African Development Community; and members of the eastern and southern Africa United Nations Regional AIDS Team. Participants were selected for representation across high-level policy, social and scientific research and programming expertise related to women, girls and HIV, from all countries of southern Africa.

Andy Seale, Senior Regional Adviser for Advocacy and Communications with UNAIDS Regional Support team for Eastern and Southern Africa, said: “A major acceleration in social mobilization, service scale-up, increased resources and better surveillance is needed to successfully address the vulnerabilities explored at the meeting. Actions are needed at all levels from the state level to actions at community, family and individual level.”

The outcomes of that meeting are reflected in a new publication launched by UNAIDS in Eastern and Southern Africa on 1 December 2008 that outlines the experts’ conclusions, recommendations and needed sets of action.

“UNAIDS Technical Meeting on Young Women in HIV Hyper-endemic countries of Southern Africa” also includes a number of the background technical papers which were commissioned for the meeting.

Southern Africa context explored

On the opening day of ICASA 2008, a new regional report is launched that looks at the vulnerability of women and girls in Southern Africa to HIV.
Credit: UNAIDS/Jacky D. Ly

The papers explore some of the factors that are driving the current epidemic in southern Africa. These include the practice of age disparate and intergenerational sex; biological vulnerability of young women; economic empowerment; education and gender-based violence. A final paper examines the complex interaction between environmental factors and individual choices, behaviours and community norms.

Improved analyses of these factors will enable appropriate and evidence-informed responses to these specific challenges that increase vulnerability of young women and girls in the region.

Social transformation

Meeting participants called for a social movement to address the drivers that contribute to the risk of HIV infection in the region. Addressing human rights violations, harmful social norms, weak community and leadership capacities are seen as some of the fundamental steps to tackle the vulnerability of young women and girls to HIV in southern Africa.

Young women in Dakar, Senegal. Credit: UNAIDS/P.Virot

Sustaining the progress that has been made in preventing new HIV infections and getting more people on antiretroviral treatment are priorities for African countries if they are to get ahead of the AIDS epidemic in the coming years – this is the overarching theme to be discussed at the 15th International Conference on AIDS and STIs in Africa (ICASA) taking place in Dakar, Senegal from 3 to 7 December 2008.

The theme of Africa's leading forum for discussion of HIV developments and trends is “Africa’s Response: Face the facts”.

Experts from UNAIDS, together with many from international and African organizations, civil society groups including people living with HIV, media, and other partners in the AIDS response, will take part in five days of sessions and open forums that will review the successes and challenges to date in Africa’s AIDS response. In particular, international and African experts will evaluate the current state of the HIV and other sexually transmitted infections (STIs) epidemics, assessing political commitments, scientific progress and challenges, community actions, and leadership.

“The AIDS epidemic is not over in any part of Africa,” said UNAIDS Executive Director Dr Peter Piot, who will open ICASA and engage in a number of events, many focused on leadership and youth engagement. “As African countries plan their next steps in addressing AIDS, it is necessary to now take stock of successes and challenges”.

UNAIDS Deputy Executive Director Michel Sidibe, UN Special Envoy Lars Kallings (for Eastern Europe and Central Asia), UNAIDS Special Representatives HRH Princess Mathilde of Belgium and Gaetano Kagwa, as well as several other prominent advocates will be present and contribute to the discussions.

Several sessions are being devoted to ‘knowing your epidemic and your response’, human rights based approaches, including tackling stigma and discrimination, addressing women’s and girl’s vulnerabilities, the role of religion and faith-based organizations, public-private partnerships, technical support to countries, tuberculosis and HIV, and financial mechanisms.

Africa’s AIDS Response

The conference is happening at a unique phase in Africa’s epidemics: the global financial and economic crisis, continued poverty and inequalities pose challenges and obstacles for countries as they find innovative solutions to reducing new HIV infections, curbing AIDS deaths, and getting more people on treatment.

Sub-Saharan Africa remains the region in the world most heavily affected by HIV – there are about 22 million [20.5–23.6 million] people living with HIV in the region.

In 2007, the region accounted for two thirds (67%) of all people living with HIV and for three quarters (75%) of AIDS deaths globally. And AIDS continues to be the leading cause of death in Africa. The nine countries in southern Africa continue to bear a disproportionate share of the global AIDS burden with 35% of HIV infections and 38% of AIDS deaths in occurring in the region.

Despite these sobering figures, progress made over the past few years show that the there are returns on investments in HIV prevention and treatment programmes. As reported in the UNAIDS 2008 Report on the global AIDS epidemic, in a number of heavily affected countries, such as Rwanda and Zimbabwe, changes in sexual behaviour have been followed by declines in the number of new HIV infections. Behaviours include waiting longer to become sexually active, fewer multiple partners, and increased condom usage among people with multiple partners.

UNAIDS and its partners are working with countries to build on HIV prevention results and encourage the implementation of combination HIV prevention as a priority approach – selecting the right mix of behavioural, biomedical and structural HIV prevention actions and tactics to suit epidemics and the needs of those most at risk. National AIDS programmes must also continue to address the factors that continue to put women and girls at risk, while at the same time heighten HIV prevention awareness for other most-at-risk groups, such as sex workers and men who have sex with men.

ICASA is expected to draw around 5,000 participants from a range of countries and backgrounds.

An estimated 122,000 teachers in sub-Saharan Africa living with HIV have been given voice in a collaborative project by UNAIDS Cosponsor the World Bank and African Ministries of Education networks of HIV/AIDS focal points.

An estimated 122,000 teachers in sub-Saharan Africa living with HIV have been given voice in a collaborative project by UNAIDS Cosponsor the World Bank and African Ministries of Education networks of HIV/AIDS focal points. The result is a book and a documentary film produced by Partnership for Child Development with support by the World Bank.

On the opening day of ICASA the African premiere screening and launch of the documentary “Courage and Hope” took place in Dakar. Don Bundy, World Bank Lead Specialist on School Health HIV/AIDS & Education introduced the film and its background.

After hearing at an education summit in 2006 how teachers living with HIV in Gabon were returning to their classrooms thanks to HIV treatment and playing new leadership roles in fighting the disease, Bundy encouraged the World Bank and the Partnership for Child Health to finance Courage and Hope.

“This kind of support for teachers helps both maintain the trained workforce and provides young people with credible adult role models,” says Bundy.

Elizabeth Lule, Manager of ActAfrica described how children have a chance to live a life free from HIV if they can acquire knowledge, skills, and values that will help protect them as they grow up. “Providing young people, especially girls, with the ‘social vaccine’ of education offers them a real chance at a productive life, free of HIV,” she said.

(from left): Debrework Zewdie and Elizabeth Lule from the World Bank and Barbara de Zalduono of UNAIDS speak to participants at the launch of Courage and Hope. Credit: UNAIDS/Mamadou Gomis

In the book twelve teachers from Burkina Faso, Cameroon, Ghana, Kenya, Mozambique, Rwanda, Senegal, Tanzania mainland, Zanzibar and Zambia vividly recount their experiences that testify to ordinary yet courageous life with HIV and the impact their HIV status has on their loves, families, schools and communities.

The vast majority of teachers living with HIV in sub-Saharan Africa are unaware of their positive status, and many are reluctant to undergo HIV testing for fear of consequences of a positive test outcome.

In the film four of the teachers—Beldina Atieno, Martin Mkug Ptoch, Jemimah Nindo, and Margaret Wambete—detail the challenges they faced once their positive status became public. These range from stigmatization to shunning and discrimination against them and their families.

“HIV does not kill. What kills is the stigma and discrimination associated with the virus,” says Beldina Atieno, a 38 year-old teacher from Kenya who learned the hard way how to cope with discrimination after being thrown out of the house by her husband and losing her children as well as her job.

Despite the personal hurdles the teachers faced, they are confident that accessing effective care, support and anti retroviral medicines, they are able to live, and to enjoy full and healthy lives. The personal reflections of these teachers offer courage and hope to the other estimated 121,996 teachers living with HIV in sub-Saharan Africa.

The film “Courage and Hope: African Teachers Living Positively with HIV” was first shown at the International AIDS Conference 2008 in Mexico and broadcast from the UNAIDS booth, where free copies of the DVD were also distributed.

At the Dakar launch, Martin Ptoch, who is a teacher living with HIV featured in the film described the positive reactions to the film and book to date. Barbara de Zalduondo, Chief, Programmatic Priorities and Support UNAIDS and Debrework Zewdie, World Bank, Global HIV/AIDS Program also spoke at the launch.

A satellite symposium to highlight the impact that TB has on people living with HIV was held on 3 December 2008 during ICASA. Credit: UNAIDS/Mamadou Gomis

TB is among the leading causes of death in people living with HIV and accounts for an estimated 13% of AIDS deaths worldwide. HIV and TB are so closely connected that they are often referred to as co-epidemics or dual epidemics. Each worsens the impact of the other, yet despite evidence of positive impact of joint interventions, TB and HIV programmes have largely been implemented independently.

Sub-Saharan Africa carries the highest burden of HIV infections and AIDS related mortality in the world, accounting for more than 60% of people living with HIV worldwide. On average, 22% of TB patients in the Region are co-infected with HIV, and approximately 40% of TB deaths are due to HIV.

TB is the most common cause of illness and death among people living with HIV in Africa, despite being preventable and curable. Rising rates of drug resistant TB, especially extensively drug resistant tuberculosis (XDR-TB), further threaten the response to AIDS in the region.

Alasdair Reid, UNAIDS HIV/TB Adviser
Credit: UNAIDS/Mamadou Gomis

For these reasons, on Wednesday 3 December UNAIDS, WHO and WFP in collaboration with the TB/HIV working group of the Stop TB Partnership organized a satellite symposium to highlight the impact that TB has on people living with HIV and what needs to be done to reduce this unnecessary burden of illness and death.

The symposium underlined what needs to be done by HIV programmes and civil society to improve the prevention, diagnosis and treatment of TB in people living with HIV. It introduced the ‘Three I’s for HIV/TB’, a package of interventions - including Intensified TB case finding (TB screening), Isoniazid preventive therapy and Infection control - that aim to reduce the burden of TB among people living with HIV. Furthermore, the need to jointly address nutrition as an essential element in the response to TB and HIV was promoted. TB and HIV both compromise the nutritional status of affected persons, leading to malnutrition, which in turn aggravates the severity of HIV and TB.

Credit: UNAIDS/Mamadou Gomis

Few countries have comprehensive plans to reduce the burden of TB among people living with HIV in the region. The consequence is that the coverage with key TB and HIV interventions is still very low. Collaborative TB/HIV activities are essential to ensure that TB patients living with HIV are able to access HIV testing and treated appropriately, and to effectively prevent, diagnose and treat TB in people living with HIV.

In 2006, only 22% of TB patients were tested for HIV in sub-Saharan Africa, and less than 1% of people living with HIV were screened for TB disease.

The symposium demonstrated the need for rapid scale up to ensure universal access to TB prevention, diagnosis and treatment services for people living with HIV in Africa.

“The ICASA symposium has helped to enhance the engagement of HIV service providers and affected communities in the implementation of these crucial interventions and strengthen collaboration between TB programmes, HIV programmes and civil society,” said Alasdair Reid, UNAIDS HIV/TB Adviser.