Delivering on the Global
Partnership for Achieving the
Millennium Development
Goals - MDG Gap Task
Force Report 2008

Important gaps remain in delivering on the global commitments in the areas of aid, trade, debt relief, and access to new technologies and to affordable essential drugs and treatment for HIV, malaria and tuberculosis. A new report by the United Nations Millennium Development Goals Gap Task Force identifies these gaps in detail and provides recommendations to all major stakeholders on how to address these gaps. In the countdown to 2015, urgent responses are needed to bridge the existing implementation gaps to make good on the promises made to achieve the Millennium Development Goals.

Inadequate access to essential medicines for HIV, malaria and tuberculosis

The findings of the report show that in some developing countries strong partnership between government, pharmaceutical companies and civil society, including consumers can lead to improved access to affordable essential medicines for HIV, malaria and tuberculosis.

However, access to essential medicines in developing countries is far from adequate. Information available in a number of countries suggests the existence of large gaps in the availability of medicines in both the public and private sectors as well as a wide variation in prices which render essential medicines unaffordable to poor people.

Millennium Development Goals Gap Task Force

The report was launched by the UN Secretary General Ban Ki-moon on 4 September. The Task Force was created by the Secretary-General following discussion of the Policy Committee on 1 May 2007 to improve monitoring of the global commitments contained in the Millennium Development Goals.

The main purpose of the Millennium Development Goals Gap Task Force is to systematically track existing international commitments and their fulfillment at the international and country level in the areas of official development assistance, market access, debt relief, access to essential medicines and technology.

The Task Force integrates more than 20 UN agencies, including participation from UNAIDS, the World Bank and the IMF, as well as the OECD and WTO. The United Nations Development Programme and the Department of Economic and Social Affairs of the United Nations Secretariat (UN/DESA) are lead agencies in coordinating the work of the Task Force.

(from left): Dr Piot together with the Belgian Minister for Development Cooperation Charles Michel and the Director-General Peter Moors speak with journalists at a press conference in Brussels.
Credit: Directorate-General for Development Cooperation

UNAIDS Executive Director Dr Peter Piot and the Belgian Development Cooperation Minister Charles Michel met in Brussels on 9 September to announce Belgium’s new four year funding agreement to UNAIDS.

This latest multiyear accord covers the period 2008-2011 and provides financial support to UNAIDS’ Unified Budget and Workplan; Belgium’s previous agreement covered the years 2004-2007.

During the meeting, Dr Piot provided Minister Michel and his advisers with an overview of the global AIDS epidemic and outlined the activities of UNAIDS and its partners in responding to HIV. Dr Piot emphasized the recent successes in providing antiretroviral treatment to three million people in low- and middle-income countries and of efforts to strengthen prevention initiatives.

The programme ensures that public health information on television has the necessary sign language for the deaf community.

To address the inclusion of the persons with disabilities in HIV-related public education the “Education and economic empowerment for persons with disabilities: Responding to HIV” programme is being implemented by  the Jamaica Council of Persons with Disabilities (JCPD) in the Ministry of Labour and Social services and is financially and technically supported by UNAIDS Jamaica.

“Individuals with disability are often overlooked in HIV prevention and AIDS outreach efforts,” said Miriam Maluwa, UNAIDS Country Coordinator for Jamaica, The Bahamas and Belize. “To ensure their inclusion in HIV-related public education, this innovative information and economic empowerment programme is being implemented as part of the national response to HIV.”

The programme provides HIV prevention information in Braille for blind and visually impaired individuals

Using a creative approach, the programme directly addresses the disabled community on the subject of HIV, customizing messages and information and delivering it in accessible formats to suit their disabilities such as providing information in Braille for blind and visually impaired individuals; texting HIV prevention messages and ensuring that public health information on television has the necessary sign language for the deaf community.

The programme is coupled with an income generation component to assist people in accessing business skills and small grants to initiate and manage their own business, thus reducing their vulnerability to HIV.

Empowering deaf women and girls

On the occasion of the launch of the HIV-related public education programme for people with disabilities the Jamaica Minister of Labour and Social Services Andrew Galimore (second from left) greets Chinese Ambassador to Jamaica Chen Jinghua. Miriam Maluwa, UNAIDS Country Coordinator for Jamaica, The Bahamas and Belize and the Panamanian Ambassador to Jamaica look on.

The programme is a scale-up of a very successful island-wide project carried out in 2006 which educated deaf women and girls, and their service providers, about HIV and on the wider issue of gender relations.

This project came about in response to results of a needs assessment survey which showed that deaf women experience gender-based violence at a disproportionate rate, particularly violence of a sexual nature including rape, battery, incest and sexual abuse. These unsolicited sexual encounters place deaf women at significantly greater risk of contracting HIV and other sexually transmitted infections.

Within the project women were empowered with self-defense and alternative economic skills to strengthen their economic independence.

The above programmes complement efforts of UNICEF and UNFPA Jamaica who are specifically addressing matters of children with disabilities and HIV and sexual reproductive rights of persons with disabilities, respectively.

Background

The disabled community constitutes one of the most vulnerable groups within Jamaica.  Statistics are show that of the approximately 200,000 persons living with a disability in the country, less than 1% of this community is in paid employment.

Participants at the launch of the programme

Through a ripple-on effect, the education and economic empowerment for persons with disabilities programme should positively impact the lives of many, preventing HIV through reducing people vulnerabilities by empowering them with knowledge and economically, equipping them with a means of generating their own income.

Dr Nafis Sadik, UN Secretary General
Special Envoy on AIDS in Asia and the Pacific delivered the closing address to the 2nd Regional Consultative Meeting.
Credit: UNAIDS

In countries with low HIV prevalence, that is, with less than 1% of the population reported to be living with HIV, there are specific challenges to an effective AIDS response. In order to assess these issues in the Asia Pacific region, the second regional consultative meeting on universal access to HIV prevention, treatment, care and support took place in Manila 26-28 August 2008.

Challenges for low prevalence countries

When a minority of the population is affected by HIV, a lower prioritization may be given to AIDS programmes alongside other competing development priorities. In addition, the epidemic can remain relatively “invisible” in a society where the main modes of HIV transmission are related to behaviours of unprotected paid sex, use of contaminated needles and syringes by people who inject drugs, and unprotected sex between men.

"Know your local epidemic"

Given these challenges, experts argue the importance for a country to understand what is specifically driving its epidemic and spends resources in a focussed way. So "knowing your local epidemic" and choosing the right combination of interventions would result in a more cost-effective and successful response.

Bringing services to where most needed

(From left) Dr. Mario Villaverde,
Undersecretary Department of Health,
Republic of the Philippines; Mr. Rico
Gustav, APN+; Hon. Lyonpo Zangley
Dukpa, Minister of Health, The
Kingdom of Bhutan; Mr. Andric Nelson,
Associate Executive Director, Ceballos,
KPGG; Hon. Nimal Siripala de Silva,
Minister of Healthcare Nutrition, Sri
Lanka; Dr. Purnima Mane, Deputy
Executive Director, United Nations
Population Fund (UNFPA); Hon.
Ratu Epeli Nailatikau, Interim Minister
of Foreign Affairs, Fiji participated in a
closing press conference. Credit: UNAIDS

The report of the independent Commission on AIDS in Asia published earlier this year found that it is vital that national responses are evidence-based and bring services to where it is most needed. However an additional challenge for low-prevalence countries is to reach these people whose behaviour may marginalize them from mainstream society– these include men who have sex with men, people who inject drugs, sex workers and their clients.

Asia and the Pacific

Despite a few notable successes in containing the epidemic, infections continue to rise throughout the Asia Pacific region and infections have reached concentrated levels in a number of countries, which were previously termed as low prevalence.  Low prevalence is not a cause for celebration, rather consistent with Millennium Development Goal 6; the call to action needs to be from low to zero prevalence.

Second regional consultative meeting on universal access to HIV prevention, treatment, care and support

In order to assess these complex issues in the Asia Pacific region, the second regional consultative meeting on universal access to HIV prevention, treatment, care and support took place in Manila 26-28 August 2008.

The three day meeting was hosted by the Department of Health, Republic of the Philippines and co-organized with support from UNAIDS and its Cosponsors. More than 100 delegates including health ministers, interim foreign affairs minister and experts from national governments, civil society and international agencies participated. The UN Secretary General’s Special Envoy on AIDS in Asia and Pacific Dr Nafis Sadik also attended, as did Dr Purnima Mane, Deputy Executive Director United Nations Population Fund (UNFPA) and Mr Prasada Rao, UNAIDS Asia-Pacific Regional Director.

The meeting reviewed the findings and recommendations of the Commission on AIDS in Asia, which included among others that Heads of Governments of Asian countries should assume stronger leadership role in national AIDS responses. It concluded with the adoption of the Manila 2008 Statement of Cooperation in which low prevalence countries in Asia and the Pacific commit to mobilizing the resources required to meet universal access targets, to scaling-up effective strategies informed by the evidence of the nature of the epidemics in these countries, and to designing context-specific programmes.

UNAIDS Executive Director meets Ghanaian AIDS groups, 3 September 2008
Credit: UNAIDS

In Ghana attending the Accra High Level Forum on Aid Effectiveness, UNAIDS Executive Director Dr Peter Piot also visited the headquarters of the Ghana Network of Persons Living with HIV (NAP+) on 3 September where he met civil society groups active in responding to the country's AIDS epidemic.

Members from Ghana Network of Persons Living with HIV (NAP+), the Society for Women against AIDS in Africa-Ghana (SWAA) and the Centre for Popular Education and Human Rights-Ghana (CEPEHRG) shared with Dr Piot the scope of their work in the country, where, in 2007, an estimated 260,000 people were living with HIV in Ghana and 21,000 died of AIDS-related illnesses.

The three organizations work jointly and with other civil society groups to provide access to HIV prevention, treatment, care and support services and to promote the health, wellbeing and human rights of those living with HIV.

(From left): Cecilia Lodonu of SWAA Ghana chats with Dr Peter Piot UNAIDS Executive Director and Dr Leopold Zekeng UNAIDS Country Coordinator, Ghana. 3 September 2008.
Credit: UNAIDS

In the lively exchanges with Dr Piot, NAP+ members explained its role as an umbrella organization for all groups active in improving the lives of people living with HIV. SWAA, as an organization dedicated to women and their families, provided an overview of the activities it carries out in six of Ghana’s ten regions, including its "positive living toolkit", while CEPEHRG members spoke on their efforts to generate awareness around, and protect, human rights for marginalized groups, in particular men who have sex with men.

CEPEHRG's community-based outreach initiatives have received recognition both nationally and internationally - most recently at the 2008 International AIDS Conference in Mexico City, where it was singled out from other Red Ribbon Award winners for special recognition for its work with men who have sex with men.

UNAIDS Executive Director Dr Peter
Piot gave the Secretary-General a
tour of the building, 31 August 2008.
Photo: UNAIDS/M. Girardin

United Nations Secretary-General Ban Ki-moon paid a visit to the UNAIDS Secretariat in Geneva on 31 August 2008.

UNAIDS Executive Director Dr Peter Piot gave the Secretary-General a tour of the building which was opened in 2006 and designed to be an inspiring work space with low impact on the environment.

Secretary-General Ban Ki-moon
and UNAIDS staff, UNAIDS Secretariat
Geneva, 31 August 2008.
Photo: UNAIDS/M. Girardin

The Secretary-General spoke of his belief in an ideal workplace that most importantly is without any sense of discrimination towards staff living with or affected by HIV and thanked members of UN Plus for broadening his horizons on this issue. He restated his personal commitment to the importance of the UN to be an enabling environment for staff living with HIV.

Secretary-General Ban Ki-moon
also took the opportunity to address
UNAIDS staff.
Photo: UNAIDS/M. Girardin

Secretary-General Ban Ki-moon also took the opportunity to thank UNAIDS staff for their work and Dr Piot for his commitment and dedication to stopping the spread of HIV and for being a vanguard of the global AIDS response. He also acknowledged UNAIDS is an example of UN reform in action, as through UNAIDS, UN country teams “deliver as one” on HIV.

While in Geneva, the Secretary-General marked the 20th anniversary of the United Nations Intergovernmental Panel on Climate Change (IPCC), co-recipient of last year's Nobel Peace Prize, and attended a memorial ceremony for the 19 August 2003 bombing of the UN headquarters in Baghdad.

The Third High-Level Forum on Aid
Effectiveness takes place this week in
Ghana.

The Third High-Level Forum on Aid Effectiveness takes place this week in Ghana. To mark this event, we begin a new web series “Making the money work”. In coming months we will explore different aspects of aid effectiveness; how financial aid to countries can be made more effective, accountable and results-oriented.

Donors and development agencies are devoting more resources than ever to, among other development goals, the AIDS response in developing countries–welcome news for the millions of people infected and affected by the epidemic. However, many governments and organizations face significant challenges to use this aid effectively and to meet the multiple and often complex requirements of different donors. To address this, the Joint UN Programme on HIV/AIDS (UNAIDS) has taken a leading role in helping countries to "make the money work".

Antonio A. Tujan Jr., Chair of the
International Steering Group of the
"CSO Parallel Forum on Aid
Effectiveness", addressed the Parallel
Forum in Accra ahead of the Third
High-Level Forum, 1 September 2008.
Credit: UNAIDS

The Third High-Level Forum on Aid Effectiveness (HLF) takes place 2-4 September 2008 in Accra and will bring together ministers from over 100 countries along with donors, civil society, UNAIDS, its Cosponsors and other development agencies.

UNAIDS Executive Director Dr Peter Piot will participate as a member of the United Nations Development Group delegation.

Participants will take stock of how aid is being delivered and used, and plan and intensify efforts for improvement in aid effectiveness in the strengthening of health systems among other development goals.

“We are seeing improvements in how development aid is being planned and delivered, but results do not yet match commitments made in Paris in 2005. The AIDS response has championed more inclusive partnerships as being key and we have pioneered the principle of ownership through the 'three ones',” said UNAIDS Executive Director Dr Peter Piot.

“It has been our collective focus on AIDS results and accountability where the response has made most progress. Those results now need to be sustained. The Paris agenda sets the framework, but we must be ambitious in what we demand from the international community as we look to the future.”

Addressing flaws in aid delivery practices

Ghana Minister of Finance and
Economic Planning, Kwadwo Baah-
Wiredu addressed the CSO Parallel
Forum on Aid Effectiveness,
1 September 2008. Credit: UNAIDS

The meeting, organized by the Organisation for Economic Co-operation and Development (OECD), the World Bank and the Government of Ghana, builds on the 2005 High-Level Forum when over 100 countries and organisations endorsed the Paris Declaration on Aid Effectiveness.

This is part of a larger movement spearheaded by organizations such as UNAIDS that started in the late 1990s when recipient countries brought forward that donors needed to support country priority setting and harmonize their approaches in order for the countries to be able to coordinate their AIDS efforts and make more efficient use of donor funding. Donors and aid agencies also progressively realized that the multiple requirements they imposed on countries drained precious resources and led to duplication of efforts.

Progress

Progress has been made in improving the alignment of global support for AIDS and in reducing the burden placed on countries and in the development and strengthening the quality of policies, institutions and processes that take the “Three Ones” principles forward.

This has resulted in improved quality and greater technical support for the development of national AIDS strategies, the mainstreaming of AIDS into development plans, development of joint UN teams on AIDS and joint programmes, and development of accountability tools. The report “Progress update and Lessons Learned from Aid Effectiveness in AIDS Responses” relates the lessons that UNAIDS has learned through its involvement in these processes.

Ghana’s experience with harmonization and coordination

Ghana is a fitting host for the Third HLF because it is a good example of harmonization in action, implementing the “Three Ones” and the recommendations of the GTT, and working towards greater alignment in its AIDS response for several years.

In 2006 Ghana established a joint UN team on AIDS, and has used participatory processes for decision-making among multiple stakeholders. This has strengthened the recognition of the Ghana AIDS Commission (GAC) as the one national authority on AIDS. It has also fostered a strong sense of national ownership of the AIDS response which led to the development of a National Strategic Framework (2006-2010) with a single National Monitoring and Evaluation Plan, developed along the lines of the key principles of the “Three Ones”.

The GAC plans to further implement these principles, in part by strengthening its partnerships with donors and by reinforcing the abilities of national actors – including community-based organizations and the private sector – to contribute in a cohesive way to the national response. It also aims to improve systems for collecting, analyzing, sharing and using AIDS data, which will lead to more evidence-informed programming which will systematically address the needs of groups at higher risk of HIV.

More work to be done

Ghana however, like many countries, still faces challenges in coordinating multiple donors, projects and processes. More coherence is needed so that the UN can “deliver as one” and help countries to scale-up their response to AIDS. The Third HLF is seen as an important opportunity to assess progress, determine next steps and step up efforts among donors, countries and UN agencies.

The survey is the result of a partnership
between IPPF, UNAIDS, GNP+ and ICW.

Much of what we know about the stigma attached to HIV and the resulting discrimination towards people living with the virus is anecdotal or fragmented. Existing surveys show that while much is known about the influence of stigma there is no clear picture of the actual magnitude of it. Stigma and accompanying discrimination are widely recognized as significant barriers to HIV prevention, treatment and care services reaching those who need them most. Without concerted action to eliminate stigma, the goal of universal access to these vital services will be impossible to achieve.

People Living with HIV Stigma Index

To address this lack of evidence, a measurement tool The People Living with HIV Stigma Index has been developed. The survey is the result of a partnership between the International Planned Parenthood Federation (IPPF), UNAIDS, the Global Network of People Living with HIV (GNP+) and the International Community of Women living with HIV (ICW). This global initiative has also received financial support from GTZ and DfID, the German and British development bodies.

With better evidence, programmes can be better directed and improved, advocacy efforts strengthened, and policy better-informed. Importantly, the initiative puts into practice the Greater Involvement of People Living with HIV/AIDS (GIPA) principle.

“It's exciting to see how interest in the Index is gaining momentum among positive networks. People are really keen to implement it in their countries and I think this is because they recognize it has been created by and for positive people, and that it can ultimately benefit their communities,” said Kate Thomson, Chief of Civil Society Partnership Team, UNAIDS.

Much of what we know about the stigma
attached to HIV and the resulting
discrimination towards people living with
the virus is anecdotal or fragmented.

During 2008 the important process of preparing for the roll-out of the Index commenced by strengthening the capacity of networks of people living with HIV and building in-country partnerships.

From 50 countries across Asia, the Pacific, Africa, the Caribbean, Latin and South America, 87 HIV positive people, representing 66 organizations, have been trained as trainers or team leaders. UNAIDS Regional Support Teams and UNAIDS Country Coordinators as well as regional partners of IPPF, ICW and GNP+ have been working together to implement these workshops.

“When it comes to crying, shouting and speaking out against stigma—I have done it. But I have been struggling with the evidence to quantify it. As a researcher and as an advocate I now have the missing link,” said Beatrice Were from Uganda who participated in the Africa regional workshop held in Nairobi, May 2008.

The People Living with HIV Stigma Index was showcased earlier this month during a special session at the International AIDS Conference in Mexico City by Anandi Yuvaraj from ICW, “the Index gives us a real opportunity to measure, understand and advocate effectively to improve policies and programmes and to make a real difference in the lives of people living with HIV.”

National implementation

The Index has been developed in collaboration with community leaders, activists, researchers and human rights advocates around the world and piloted in Kenya, Lesotho, Trinidad and Tobago, India and South Africa. The first full-scale national implementation of the Index is underway in the Dominican Republic and findings and initial analysis will be published towards the end of 2008.

The results coming from this process will be revealing. As Andell Simon, a researcher involved in the pilot phase held in Trinidad in 2006 said, “being interviewed by another person living with HIV does make a difference as you feel that they really understand more about how you feel about things related to being HIV positive.”

For more information visit the recently launched web site www.stigmaindex.org or contact the project coordinator at IPPF, Lucy Stackpool-Moore lstackpoolmoore-at-ippf.org (replacing -at- with @).

Belize: A programme coordinator with a
former gang member now actively involved
in HIV prevention and violence reduction
programmes. Credit: Carina Wint/UNFPA

HIV prevention is about saving lives. UNAIDS cosponsor, the United Nations Population Fund (UNFPA), has published an advocacy booklet telling the personal stories of people and communities who are making a difference in many corners of the world. "Prevention is for Life" puts a human face to these prevention efforts by telling real stories and accompanied by stunning photography.

In recent years, we have seen a substantial increase in HIV prevention efforts, and they are producing results in a number of heavily affected countries. However, the AIDS epidemic is not over in any part of the world—for every two people accessing HIV treatment, five are newly infected. HIV requires a long term response that is grounded in evidence and human rights.

The booklet starts with the story of how HIV peer education projects in street gangs in Belize are empowering young people to take responsibility within the youth community. In another corner of the world, Yulia is a young HIV-positive mother in Moscow struggling with stigma as well as the health impact of HIV but in her story she is hopeful for a brighter future for the next generation.

Tajikistan: Two young women share a
tender moment at UNFPA-sponsored Guli
Surkh, an NGO located in Dusnabe. Credit:
Warrick Page/UNFPA/Panos Pictures

A story of a micro-credit project in Tajikistan illustrates the connection between poverty, gender inequality, and vulnerability to HIV. With access to the micro-credit, migrant wives can gain financial independence and support their families. Again, it underlines that HIV is a development and human rights issue.

In China, messaging and condom promotion campaigns have been launched reaching out to the country’s large migrant population. In Egypt, HIV prevention services are reaching people who risk exclusion as mobile clinics and voluntary counselling and testing services are delivered to people living in Cairo’s poorest neighbourhoods.

Although HIV information, counselling, services and commodities such as male and female condoms are not revolutionary prevention concepts, ensuring access to these prevention tools is a challenge. This booklet shows vividly that it’s a challenge worth taking on as access to HIV prevention is making a real difference in people’s lives.

The MTV Staying Alive Foundation invites grant applications from youth-led organizations and young people who are working on HIV prevention and AIDS education campaigns within their communities

The MTV Staying Alive Foundation invites grant applications from youth-led organizations and young people (aged between 15-27 years) who are working on HIV prevention and AIDS education campaigns within their communities.

The deadline for December 2008 proposals is the 15th September 2008, and successful applicants will be announced on World AIDS Day, 1 December 2008. Young people, 15–24 years of age, accounted for around 45% of all new HIV infections in 2007 and many young people lack accurate, complete information on how to avoid exposure to the virus. The Staying Alive Foundation (SAF) believes that the information geared towards young people is one of the keys to helping prevent HIV infection and that young people can bring about positive social change around HIV prevention, if given the opportunity.

A Staying Alive Award comes with a financial grant up to US$ 12,000, Staying Alive materials (including MTV Staying Alive programming and teaching kits), a small fund to buy technical media equipment, a local mentor and a personal grant manager.

About Staying Alive

In 1998, MTV launched the Staying Alive campaign, a multimedia global HIV prevention campaign to challenge AIDS-related stigma. UNAIDS has partnered with MTV, providing funding and technical assistance on key AIDS issues.

Following the success of the campaign, the Staying Alive Foundation (SAF) was set up in 2005 to support young people around the world who are working in AIDS awareness, education and prevention campaigns among their peers. To date they have given 100 grants to 81 projects across the globe.

If you have any further questions then email at foundation@staying-alive.org