Before she sets out to visit her client Ms. Heluda in Kisian, Yvonne prepares a bag with a towel, multivitamin tablets, over-the-counter painkiller tablets, a packet of porridge flour, liquid detergent, hand gloves and soap. Then, she takes a bicycle taxi to Kisian village, 12 km away.

On her arrival at Ms. Heluda’s home Yvonne is met by three young children who are not in school today because their mother was too sick to get up this morning and has been too weak to cook for them, she is HIV-positive.

Yvonne Awuor is a volunteer home-based care provider in Kenya with WOFAK (Women Fighting AIDS in Kenya) an organization founded by women to give support and reach out to other women experiencing discrimination as a result of being affected by or infected by HIV.

Yvonne talks with Ms. Heluda and makes the fire to prepare porridge for her and the children. She then helps her to take the cup of porridge, perhaps her only food intake that day and bathes her face, hands, feet and body. She applies massage oil and massages her feet, hands and shoulders. After chatting with her about the importance of taking care of herself and the need to take her HIV medications so that she will get stronger, Yvonne later returns to town by bicycle taxi, promising to visit again in three days time.

Home-based care ensures a continuum of care for people living with HIV who have left hospital and returned home. It offers a holistic approach often including palliative and spiritual care. However, in most areas, providing care for people living with HIV would be far more difficult and in many cases impossible without a bicycle.

“We use bicycles in Kisumu because it is the cheapest means of transport for our caregivers. We also use the bicycle as it offers a more convenient way of reaching remote places within our area”, says Dorothy Onyango, Director of WOFAK. “In many cases, our caregivers are one of the best sources of hope and inspiration for the sick person and the family members. Such visits are therefore received with joy,” she added.

In Namibia, the non-governmental organization Bicycling Empowerment Network (BEN) was set up to respond to the need for affordable transport by providing bicycles and maintenance training to home-based care volunteers. Through field research they found that in this vast country rural Namibians have extremely poor access to emergency medical transport and that the cost and non-availability of transport has a particularly negative impact on adherence to antiretroviral treatment for people living with HIV.

“Bicycles benefit the caregivers, clients and their families,” says Michael Linke, Director, BEN Namibia.

In urban settings with good roads, bicycles can increase the range and carrying capacity of people by four or five times compared with walking. Even on un-tarred rural tracks a bicycle carries up to four times the weight, goes twice as far and travels twice as fast as a person walking.

However according to Linke a bicycle is much more than a practical mode of transport.

“Both volunteers and clients have told us that their sense of pride in the home-based care service increases when the volunteer has a bicycle to make her visits. We didn’t expect that a bicycle would also affect the clients’ perception of the services.”

In addition to bikes for delivering home-based care, BEN Namibia has also purchased 93 bicycle ambulances to take people over what are often long distances to the nearest health clinics and so improving access to healthcare for people living with HIV.

In countries like Kenya and Namibia the volunteers who bring home-based care services to people living with HIV form the backbone of the response to AIDS. Bicycles are playing an important role enabling them to visit clients more often, spend longer with them, deliver more supplies including antiretroviral treatment, and reach more distant locations.

As part of a joint HIV prevention campaign, some 100,000 high-quality condoms are being made available to athletes free of charge in health clinics in the Olympic Villages of Beijing, Qingdao and Hong Kong. Athletes are also able to find useful information on HIV from thousands of posters and leaflets in English, French and Chinese.

In the waiting room of the polyclinics, HIV prevention videos with UNAIDS Special Representative and German footballer Michael Ballack and Chinese basketball star Yao Ming are being shown in three languages. In addition, all athletes competing in the 2008 Olympic Games have received flash sticks that include fact sheets on HIV.

These HIV prevention and anti-discrimination efforts are part of the 2008 Olympics HIV campaign “Play safe – Help stop HIV” launched by UNAIDS, International Olympic Committee (IOC), and the Beijing Organizing committee of the Olympic Games (BOCOG). The objective of the campaign is to educate athletes participating in the Beijing Games about HIV and encourage them to be ambassadors of AIDS response.

“Athletes should know about how HIV can be transmitted, how it does not transmit and how HIV can be prevented. This will help them educate their peers and fight discrimination against people with HIV. It really is a topic relevant to sport,” said Campaign Ambassador and Egyptian swimmer Rania Elwani.

The campaign not only aims to benefit the many athletes taking part but also members of the national delegations and the more than 100,000 volunteers.

Today about 33 million people are living with HIV worldwide. Young people, 15–24 years of age, account for around 45% of all new HIV infections in 2007. However, many young people still lack accurate, complete information on how to avoid exposure to the virus.

Many young people are involved in sport, either as spectators or participants. Through this global sport gala of the Beijing Olympics, messages about AIDS can reach out to communities, especially to youth, to promote safer sexual behavior and to stop stigma and discrimination.

“Famous athletes can play an important role to bring across messages about HIV prevention, care and support as they are regarded as role models by young people," said IOC President Jacques Rogge. UNAIDS Country Coordinator Dr Bernhard Schwartländer said, “We know that sport and the Olympic Games are universal languages that can play a very important and positive role in raising AIDS awareness and reducing stigma and discrimination of people living with HIV.”

In 2004, UNAIDS signed a Memorandum of Understanding with the IOC, combining efforts to enhance the role of sports organization in the AIDS response at community and national levels, and to organize AIDS awareness activities with coaches, athletes and sport personalities.

A range of initiatives by UNAIDS in China in partnership with the Chinese Government and the International Olympic Committee (IOC) in the run-up to the 2008 Games illustrate how sport can break down barriers, fight discrimination and make a difference in the AIDS response.

China’s Olympic effort to raise AIDS awareness

Long before the athletes from all over the world gathered to share dreams at the Olympic Games, tens of thousands of builders have been working hard on construction sites around Beijing to prepare for the event. Many of the people working on sites such as the famous Olympic Stadium, the Bird’s Nest are migrant workers.

Migrant workers are particularly vulnerable to HIV as they are often far away from their families for prolonged periods of time.

In a bid to address the needs of migrant workers in the run up to the Olympics, the Chinese AIDS/STD Prevention and Control Foundation and the Beijing Health Bureau, in conjunction with UNAIDS, rolled out an AIDS awareness campaign at more than 20 Olympic sites over a six month period prior to the games.

Planting trees for AIDS in China

Many people living with HIV actively participated in Beijing’s preparation to host the Olympics Games. They have put a human face to the AIDS epidemic and helped reduce discrimination and stigma.

The Beijing Health Bureau in collaboration with local HIV advocacy groups ran a year long project where trees were planted and watered and small plates with names were tied to the trees. This initiative can trace its history back to 2006 when a group of people living with HIV decided to get more involved in public events and reduce AIDS-related stigma and discrimination.

UNAIDS and UNICEF Special Representative Her Royal Highness Princess Mathilde of Belgium joined one such tree planting event in 2007. Her Highness said: “You are showing us the way, working together to make Beijing greener for the well-being of all.”

Carrying the Olympic flame for people living with HIV in Tanzania

Beyond China, Dhamiri Mustapha, a young Tanzanian woman living with HIV was one of the 80 dignitaries who carried the Olympic flame during the five-kilometre torch relay in Dar Es Salaam, Tanzania, in April this year.

The twenty-three-year old woman showed extraordinary courage by taking part in this high-profile event in her own country. She spoke openly about the importance of condom use and urged young people to protect themselves.

In a joint message, IOC President Jacques Rogge and Dr Peter Piot Executive Director of UNAIDS, underlined how sport can break down barriers, fight discrimination and make a difference in the AIDS response. "Sport offers a perfect platform to make young people aware of the issue, to promote preventive messages, and to ensure that people living with HIV are not discriminated against. Discrimination towards a country, or a person on grounds of race, religion, politics, gender, or otherwise, is incompatible with the principles of the Olympic Movement.”

Olympics 2008: AIDS awareness training for young volunteers in China

Games have begun and as Ambassadors of the host city, young Olympic volunteers are welcoming international guests to Beijing.

As part of their preparation for the Beijing Olympic and Paralympic Games, around 7,500 volunteers at 13 universities have learned knowledge and skills on HIV prevention and how to counter discrimination through games, presentations, quizzes and interactive question and answer sessions. In parallel, 100, 000 volunteers received a basic information package on HIV before the Games.

People living with HIV participated in the training session as trainers. Their presence helped to eliminate false ideas and preconceptions about people living with HIV.

The Olympic volunteer training programme was convened by UNAIDS and United Nations Volunteers (UNV) and implemented in collaboration with the United Nations system in China, Beijing Youth League, Red Cross Society of China and Marie Stopes International (MSI) China.

The role of sport

UNAIDS and the International Olympic Committee have been working closely together since 2004 when they signed a Memorandum of Understanding in which both organizations agreed to combine their efforts to raise awareness about HIV.

Leaders, policymakers, academics, scientists and activists from around the world descended on Mexico City from 3-8 August 2008 to assess progress in the AIDS response and to identify future priorities in scaling up global efforts to stop the HIV epidemic.

Under the theme “Universal Action Now!”, AIDS 2008 has called for a renewed commitment from the international community to strengthen the scale up of HIV prevention, treatment, care and support programmes worldwide, with the aim to provide universal access to these services by 2010 and to work towards achieving the Millennium Development Goals – which includes the target of halting the spread of HIV by 2015.

Preventing the transmission of HIV received significant focus during the five-day conference, as participants contributed to sessions that addressed the complexity of the epidemic and underlined the importance of “knowing your epidemic and knowing your response”. HIV prevention successes and failures to date were analyzed, leading to a greater understanding that “combination prevention” is as necessary as “combination treatment” when it comes to stopping the HIV epidemic– because for every two people that began antiretroviral treatment last year, five became newly infected.

Providing antiretroviral treatment, combating HIV-related stigma and discrimination, strengthening health systems, finding an HIV vaccine, as well as responding to broader human rights for people living with HIV were some of the other top issues discussed at the conference, the first to be held in Latin America.

While AIDS 2008 has followed the release of the UNAIDS 2008 Report on the global AIDS epidemic, which points to significant progress in reducing new HIV infections and AIDS-related deaths in the past two years, the conference underscored the fact that AIDS is not yet over in any part of the world – a point stressed by UNAIDS Executive Director Dr Peter Piot and other leaders involved in the AIDS response.

At the very heart of the XVII International AIDS Conference was the Global Village, an area of over 8,000 square metres open to everyone including community organizations from around the world, local and national groups and the general public. Open and active discussions took place highlighting stories of grassroots victories along with the challenges that communities face and opportunities to improve their response to the epidemic.

The International AIDS Conference is the world’s largest HIV forum. It is held every two years and organized by the International AIDS Society, together with a series of partners including UNAIDS. The next conference will be in Vienna, Austria in July 2010.

Representatives of 25 Red Ribbon Award 2008 winning communities were guests of honour at a formal Award Ceremony and Dinner, held last night in Mexico City and attended by government officials and global AIDS leaders. UNAIDS Executive Director Dr Peter Piot addressed the Awards Ceremony at which five organizations were selected by a jury for special recognition in the following categories:

1. Providing access to treatment, support and care
2. Supporting children orphaned by AIDS
3. Promoting human rights
4. Empowering women and girls
5. Providing HIV prevention programs and services

The communities singled out for special recognition are:

1. Centre for Popular Education and Human Rights, Ghana
2. Sanghamitra, A Women’s Collective, India
3. Hamyaran Mosbat – The Mashhad Positive Club, Iran 
4. Consol Homes, Malawi
5. Fortalecidendo la Diversidad, Mexico

Each of the 25 winning organizations received USD 5,000 and the five communities receiving special recognition an additional USD 15,000.

“These are extraordinary organizations helping to meet the needs of their own communities in often very difficult circumstances,” said Rebecca Grynspan, Director of the Regional Bureau for Latin America and the Caribbean of the United Nations Development Programme (UNDP), during the awards ceremony.

“In doing so they have shown extraordinary creativity, courage and leadership in responding to the epidemic and achieving tangible results with limited resources.”

“All the Red Ribbon participants at this conference are winners,” said As Sy, Director of Partnerships and External Relations, Joint United Nations Programme on HIV/AIDS (UNAIDS).

“We hope that the knowledge and resources gained from AIDS 2008 will help inspire you in your own communities in taking your work to the next level. I know all of us have learned from you and your experiences. This knowledge is truly what the Red Ribbon Awards are about.”

AIDS 2008: Community Dialogue Space

The 25 Red Ribbon Award 2008 winning organizations are also participating in the XVII International AIDS Conference, in Mexico City 3-8 August 2008 where they are hosting the Community Tequio in the heart of the Global village. “Tequio” is an Aztec word conveying a collective work that benefi¬ts the community and the goal is developing an enabling environment for community participation in the AIDS response.

The Community Tequio is a space for conference participants from around the world to interact and share their experiences to strengthen an international network of community best practices on HIV. Open and active discussions are taking place highlighting stories of grassroots victories, challenges communities face and opportunities to improve their response to the epidemic.

Red Ribbon Award

The Red Ribbon Award is presented every two years at the International AIDS Conference to recognize and celebrate outstanding community leadership and action that is helping to stop the spread of HIV and mitigate the impact of AIDS. This year, more 550 nominations were received for the award from 140 countries around the world.

The Red Ribbon Award Secretariat is hosted and by UNDP and supported by the XVII International AIDS Conference, the Canadian International Development Agency, Irish Aid and the Norwegian Ministry of Foreign Affairs. It is a UNAIDS family initiative.

25 years into the global AIDS response it is clear that advances made in HIV prevention have not been sufficient to get ahead of the epidemic.

The Lancet in conjunction with UNAIDS has produced a special series of six major articles on the future of global HIV prevention and held a lunchtime symposium with the authors and editors on 5 August during the International AIDS conference Mexico City.

The papers address the history of the global response to HIV, the evidence for biomedical interventions, how to improve behavioural approaches, addressing and understanding structural approaches, and how to make HIV prevention programmes work more effectively. They cite the successes and failures in HIV prevention to date, and conclude with a call to action for combination prevention to be implemented on a massive scale.

Coming to terms with complexity

The sixth article, by UNAIDS Executive Director Dr Peter Piot*, argues that the key challenges to more effective HIV prevention lie in addressing sex, including being frank with young people; dealing with drug use rationally, and looking to the long term.

“Coming to terms with complexity” proposes that tailored “combination prevention” is as necessary as “combination treatment” when it comes to stopping the HIV epidemic. The paper explores the core technical, political and capacity gaps which stand in the way of fully effective combination prevention and is a call to action to overcome these challenges and to sustain an HIV prevention movement that mobilizes to curb HIV transmission globally.

*Authors of “Coming to terms with complexity: A call to action for HIV prevention”: Peter Piot (UNAIDS), Michael Bartos (UNAIDS) Heidi Larson (Clark University/Harvard University), Purnima Mane, (UNFPA), Debrework Zewdie (World Bank).

Call to action We urge governments, communities and scientists to fully implement combination HIV prevention, and urge the international community to mobilize all the support necessary for this effort. We call for sustained political and technical leadership for the AIDS response We urge international institutions, national governments, and community activists to work to build demand for HIV prevention We urge scientists, research funders, and programme planners to broaden the HIV-prevention research agenda We call for immediate investment in building capacities at all levels for HIV-prevention efforts

The Lancet

As a leading independent journal of global medicine, The Lancet is committed to advancing health for all people around the world. It publishes research aimed at changing medical practice and adding informed analysis and opinion to scientific and policy debates. The aim of the The Lancet Global Health Network site is to bring together international scientific and public health experts. The network synthesizes evidence, conducts new analyses, devises programmatic recommendations, and formulates proposals for action in international health and development. The series can be accessed on The Lancet Global Health Network web site

The Lancet Series on HIV Prevention

1. The history and challenge of HIV prevention Jeffrey O'Malley

2. Biomedical interventions to prevent HIV: Evidence, challenges and the way forward Nancy Padian

3. Behavioral strategies to reduce HIV transmission: How to make them work better Thomas Coates

4. Understanding and addressing structural factors in HIV prevention Jessica Ogden

5. Making HIV prevention programmes work Stefano M Bertozzi

6. Coming to terms with complexity: A call to action for HIV prevention Peter Piot

In 1981 the first cases of unusual immune system failures were identified among gay men, women and injecting drug users. Some seven years later a group of prominent scientists from around the world came together to found the International AIDS Society (IAS) – an organisation which would organise international conferences on AIDS bringing together scientists, activists, researchers, people living with HIV and others working on AIDS issues to share knowledge and experiences in responding to the epidemic.

Since this time the IAS has convened the world’s largest meetings on HIV which are now held every two years.

2008 marks the 20th anniversary of the IAS and to commemorate the last 20 years, the IAS held a special event during the XVII International AIDS Conference which is taking place in Mexico from 3-8 August 2008.

The event brought together a number of past IAS Presidents, including Dr Peter Piot, UNAIDS Executive Director and Founding President of the IAS, and UN Special Envoy for AIDS in Eastern Europe and Central Asia Professor Lars O. Kallings.

Professor Kallings spoke about the IAS in the early years of the epidemic and Dr Piot looked to the future and spoke of the long term response to the epidemic. Kate Thomson, Chief of Civil Society Partnerships at UNAIDS gave a history of the involvement of people living with HIV in both the International AIDS Conference and the response to the epidemic

At the very heart of the XVII International AIDS Conference is the Global Village, an area of over 8,000 square metres open to everyone attending AIDS 2008, including community organizations from around the world, local and national groups and the general public.

On 4 August, United Nations Secretary-General Ban Ki-moon and UNAIDS Executive Director Dr Peter Piot officially opened the Village which for the coming week will be a space where thousands of visitors—the general public, communities living with and affected by HIV, policy-makers, researchers and other stakeholder groups—will interact and debate, share knowledge and skills, build coalitions and exchange ideas.

The aim of the space is to enable greater civil society involvement and strengthen diverse communities’ involvement and participation in shaping the response to HIV.

The shifting dynamics of the AIDS global financial architecture were explored in depth at a Special Session held on 5 August during the International AIDS Conference taking place in Mexico.

The interactive session brought together leaders from major AIDS donors and recipient countries including the United Kingdom, Ethiopia, Botswana and the Netherlands, as well as UNAIDS, WHO, the Global Fund, the World Bank, PEPFAR and civil society advocates, to reflect on the challenges posed by the current global funding architecture in delivering effective and efficient AIDS programmes.

The panelists explored the complex dynamics facing recipient governments and implementers, donor governments and other financial mechanisms, and global agencies. In the past five years, financial resources for the AIDS response have significantly increased and there has been a rapid scale-up of programming in the context of commitments to achieve universal access to HIV prevention, treatment, care and support services by 2010. The goal is to ensure that HIV programmes are evidence-based and meet international standards, and the challenge is to “make the money work”.

Michel Sidibe, Assistant Secretary-General and Deputy Executive Director of Programmes, UNAIDS, discussed the challenges to ensuring that global standards are upheld as services are scaled up.

As well as advocating for the need to build adequate and sustained long-term financing for HIV programmes, Mr Sidibe spoke of the importance of strengthening health systems and improving coordination and harmonization. Mr Sidibe was instrumental in developing and implementing the “Three Ones” principles to better coordinate national AIDS responses.

The session was co-chaired by health economist Professor Jean-Paul Moatti and the Dutch AIDS Ambassador Paul Bekkers.

Participants:

Malcolm McNeil, Team Leader within the Policy and Research Division at the UK Department for International Development.

Michel Sidibe, Assistant Secretary General and Deputy Executive Director of Programmes UNAIDS

Ambassador Mark R. Dybul, United States Global AIDS Coordinator

Joy Phumaphi, Vice President of the World Bank’s Human Development Network

Alvaro Bermejo, Executive Director, International HIV/AIDS Alliance

Tedros Adhanom Ghebreyesus, Minister of Health of the Federal Democratic Republic of Ethiopia

Professor Michel D. Kazatchkine, Executive Director of the Global Fund to Fight Aids, Tuberculosis and Malaria

Mphu Keneiloe Ramatlapeng, Minister of Health and Social Welfare of Lesotho

Hiroki Nakatani, Assistant Director-General - HIV/AIDS, TB, Malaria and Neglected Tropical Diseases, World Health Organization

With great celebration and a characteristically warm Latin American welcome, the XVII International AIDS Conference opened on Sunday 3 August in Mexico City. Thousands of delegates from all over the world will spend the next week participating in conference sessions, satellite meetings, exhibitions as well as the Global Village and a wide cultural programme.

The event, the largest AIDS conference in the world, is held every two years and in 2008 for the first time it is taking place in the Latin America region.

The opening event included welcoming remarks by AIDS 2008 Co-Chairs, Dr Pedro Cahn and Dr Luís Soto Ramírez and addresses by high level dignitaries including Dr José Ángel Córdoba Villalobos, Secretary of Health, Mexico; Dr María Teresa Fernández de la Vega, First Vice President of Spain and Minister of the Presidency; Dr Denzil Douglas, Prime Minister of St. Kitts and Nevis and President Felipe Calderón Hinojosa, President of Mexico.

Representing the United Nations, Secretary General of United Nations, Ban Ki-Moon; Executive Director of UNAIDS Dr Peter Piot and Director General of World Health Organization Dr Margaret Chan also addressed the opening ceremony.

Twelve-year old Keren Dunaway-González from Honduras gave the Youth Welcome address and the Community Welcome was by Mony Pen from Cambodia

The opening of the XVII International AIDS Conference also featured the Red Ribbon Award Recipients and entertainment by the Mexican Folk Ballet Amalia Hernández and the music group “HIV is not a rock band!” and was broadcast live in Global Village.

World leaders and HIV experts join community activists

The conference theme, Universal Action Now! emphasizes the need for continued urgency and action on the part of all involved in the worldwide response to AIDS.

AIDS 2008 is convened by the International AIDS Society. Local partners include the Federal Government of Mexico, the Government of Mexico City and local scientific and community leadership. International institutional partners for AIDS 2008 include: Joint United Nations Programme on HIV/AIDS, and its cosponsors, the World Health Organization and World Food Programme; International Council of AIDS Service Organizations; Global Network of People Living with HIV/AIDS /International Community of Women Living with HIV/AIDS; World YWCA; and the Asian Harm Reduction Network.