“Only” doesn’t work for HIV prevention.

UNAIDS advocates that countries implement HIV prevention programmes that will be truly effective in reducing new HIV infections. This requires a strategic combination of interventions that address populations that are at risk or vulnerable for transmission and that utilize behavioral and social change methods that are appropriate and informed by the latest evidence.

The word “only” doesn’t work for AIDS—whether it’s for treatment only, HIV prevention only, condoms only, abstinence only or male circumcision only. In reality we need it all—a truly comprehensive approach. For UNAIDS, the three pillars of a comprehensive and effective AIDS response, as we move towards universal access, are HIV prevention, treatment and care and support.

Since its establishment in 1996, UNAIDS has supported comprehensive approaches to HIV prevention, applying a combination of strategies that respond to actual needs. Countries should determine the right combination of HIV prevention interventions through an analysis of the current epidemic and the state of the national response. Part of this analysis should include an understanding of the effectiveness in the relevant populations and settings. This approach was endorsed by the member states when they adopted the UNAIDS policy position paper on intensifying HIV prevention in June 2005.

Recently in a Policy Forum article in Science, Dr. Malcolm Potts and nine colleagues call for “Reassessing HIV Prevention.” UNAIDS definitely agrees that programmes should undergo regular monitoring and evaluation of impact, but we disagree on the narrow prescriptions that these authors provide. These include their interpretations of the linkages of HIV and poverty, the effectiveness of condoms and HIV testing and counseling as HIV prevention tools, the need to prioritize male circumcision and the reduction of sexual partners, at the expense of other HIV prevention programmes. We also wish to clarify UNAIDS’ assessment of resource needs for HIV prevention in countries with generalized HIV epidemics.

Read full UNAIDS response (pdf, 32.8 Kb)

The annual Jackson Hole Film festival (JHFF) begins on 6 June in Wyoming, United States of America.

 

This leading independent film festival has always been committed to creating a platform for global inspiration and change. In this, it’s fifth year, it is inviting senior UN officials to discuss ways to engage the world on neglected issues with media figures and members of the film industry.

In addition to the screening of 100 independent films and documentaries, the Festival is hosting the first Global Insight summit in partnership with the United Nations. UN Secretary-General Ban Ki-moon will open the event which takes place Saturday 7 June 2008 which will be open to the public.

The aim of this event is to host a dialogue on critical global issues. The Festival organizers hope that Global Insight summit be a meaningful forum for exchange between senior UN officials and writers, producers and directors from film and television.

Children and HIV

UNAIDS Deputy Executive Director Deborah Landey will moderate a panel on children and HIV.

The numbers are stark. Half of all new HIV infections worldwide are in young people aged 15-24. Large numbers of young people are sexually active at an early age, are not monogamous, and do not use condoms regularly. Young people may not always be able to negotiate safe sex and in addition, may experiment with alcohol and drugs, including injection drugs, which further expose them to HIV.

The mass media has an important role to play in promoting greater awareness and understanding of HIV and communicating about its prevention.

Many others are directly affected by AIDS. Over 15 million children under 18 have lost one or both parents to the disease and countless others become responsible for the care of their siblings and other family members when parents are debilitated by poor health. As a consequence children become more vulnerable to poverty, homelessness and school drop-out.

Globally in 2007, 2.1 million children under the age of 15 were living with HIV, 420,000 had been newly infected and 290,000 died due to the disease. Most of these were infected with the virus while still in the womb, during birth or while breastfeeding. Salman Ahmad, renowned Pakistani singer and UNAIDS Special Representative will also participate, sharing how he addresses—through his music and performances—the challenge of stigma against those living with and affected by HIV. Countering stigma and discrimination towards young people living with HIV is vital to ensure their fullest integration and participation in society.

UNICEF Executive Director, Ms Ann Veneman will moderate a panel on children and armed conflict.

Complementing the Summit will be a selection of films that exhibit the power of media to address global issues. Through a juried selection process, the Global Insight Film Award will be given to the film that best demonstrates the use of film to help highlight an important global issue.

As HIV directly impacts the lives of employees and partners it impacts business. Standard Chartered Bank has been actively engaged in the AIDS response for almost ten years. “Living with HIV” is the Bank’s workplace HIV programme, a comprehensive package that delivers HIV education via face-to-face peer education sessions supplemented by an online e-Learning module.

Standard Chartered has run “Living with HIV” on a global basis since 2003, and all its employees (currently over 73,000) are required to complete it no matter where they are based, unlike other companies that run HIV programmes on a geographical and prevalence basis.

The peer programme is conducted by a network of employees who volunteer their time to educate and raise awareness about HIV. There are currently more than 800 “HIV Champions” across fifty countries so approximately one per 100 staff members.

The objectives of the “Living with HIV” programme include educating staff on prevention to encourage changing risky behaviour; reducing stigma in the workplace and encouraging HIV testing so that those living with the virus can get appropriate support.

The Bank supports this with a non-discriminatory Group Policy on HIV and AIDS as part of its company policy on the protection and enhancement of human rights in the workplace and equal opportunity regardless of color, race, gender and ethnicity.

Responding to AIDS makes business sense

The origin of Standard Chartered’s response to AIDS stemmed from Country Managing Directors, particularly in Africa, seeking human resource policy advice on the management of employees living with HIV. As HIV started to impact profitability through the loss of personnel, absenteeism, medical and welfare costs, the Bank realized that the impact of HIV was likely to be significant and that it must take action. Standard Chartered’s long-term response to HIV began in 1999 when it initiated an AIDS campaign called, “Staying Alive", which was later rolled out across twelve African countries.

Sharing best practice externally

 

In 2006, Standard Chartered pledged to the Clinton Global Initiative to educate 1 million people about HIV by 2010. The Bank is freely sharing its HIV educational products and techniques with other organizations and the “HIV Champions” will train peer educators within partner companies.

As part of this commitment, the bank is working with the Global Business Coalition to identify potential partner organizations that will roll out its HIV education programme, which it has already shared with customers, suppliers, governments and wider communities.

UNAIDS, the International Labour Organization and Standard Chartered are working together on an assessment of updated HIV education tools.  

Leadership in the private sector AIDS response

As an estimated two out of three people living with HIV go to work each day, UNAIDS and its cosponsor ILO, believes the workplace is one of the most effective settings for responding to the epidemic.

“UNAIDS recognizes Standard Chartered Bank as a valuable advocate and true business leader in the AIDS response,” said UNAIDS Private Sector Partnerships Chief, Regina Castillo. “International workplace programmes such as “Living with HIV” are a best practice that show that raising staff awareness of HIV is a win-win investment in the future of both their employees and their business.”

Standard Chartered’s AIDS business leadership has been recognized by a number of awards including the Global Business Coalition's 2007 Outstanding Business Action Award for Core Competency.

The Bank also supports community investment projects on AIDS and is currently reviewing medical aid packages in Africa in order to improve employee access to HIV treatment.

Standard Chartered has a history of over 150 years in banking and an extensive global network of over 1,200 branches in 56 countries in the Asia Pacific Region, South Asia, the Middle East, Africa, the United Kingdom and the Americas.

UNAIDS supports businesses becoming more involved in the AIDS response through its Private Sector Partnerships unit. For more information, please contact Regina Castillo Chief Private Sector Partnership. Tel: +41 22 791 4244 castillor@unaids.org

UNAIDS* and The Global Fund to fight AIDS, Tuberculosis and Malaria signed in Uganda a revised Memorandum of Understanding which renews a commitment for a coordinated response to AIDS and it serves as an umbrella framework to strategically guide their partnership to strengthen support to national AIDS responses.

The development of the present agreement, which has been revised and approved by the UNAIDS Programme Coordinating Board and the Board of The Global Fund, is based on an analysis of the current situation and a clear definition of the complementary roles of UNAIDS and The Global Fund.

Through this Memorandum of Understanding, The Global Fund and UNAIDS will collaborate to strengthen the global response to the AIDS epidemic and to accelerate progress towards universal access and the Millennium Development Goals (MDGs).

The current agreement focuses on three core activity areas:

1.- Strategic analysis and policy advice
2.- Provision of technical support
3.- Monitoring and evaluation.

Therefore, by signing this agreement, they intend to improve national AIDS responses by financing evidence-based country proposals, providing technical support to countries, support development of National Strategic Plans, improve M&E systems or build capacity of national stakeholders.

The overarching objectives upon which this agreement was developed are:

1. To move towards achieving universal access to HIV prevention, treatment, care and support by 2010
2. Empowering inclusive national leadership and ownership
3. Improving aid effectiveness through financing national plans, consolidating grants, and defining shared monitoring indicators with major partners
4. Increase advocacy and partnerships to ensure high level political support and a multi-sectoral approach for a comprehensive response to AIDS.

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 *The term UNAIDS refers to the Secretariat and its ten Cosponsors. The engagement of UNAIDS cosponsoring agencies with The Global Fund Secretariat, however, is not limited to the provisions of the present Memorandum of Understanding and not all Cosponsors are necessarily involved in every and all UNAIDS activities covered by this MoU. UNAIDS Secretariat and relevant Cosponsors will develop in partnership with The Global Fund follow-up operational arrangements under the framework of this Memorandum of Understanding.

What is an HIV implementer? Depending on whom you ask at the 2008 Implementers’ Meeting in Kampala, Uganda, which starts today, June 3, you may get varying responses. But one common thread is likely to run throughout – the drive to share lessons learned and best practices on how HIV services are delivered to people affected by the AIDS epidemic.

Over the next five-days, some 1,700 participants – from governments, NGOs, international organizations, including UNAIDS and other UN partners, the private sector and groups of people living with HIV – will exchange ideas and give examples of efforts to overcome obstacles in implementation of HIV treatment, prevention, care and support.

A co-sponsor of the meeting, UNAIDS, together with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, UNICEF, the World Bank, WHO, and the Global Network of People Living with HIV (GNP+), will share examples of its work, and that of its cosponsors and other partners, in supporting countries in HIV programme implementation.

UNAIDS’ senior colleagues and thematic experts will participate in several events, from plenaries and sessions to satellites, focused on: addressing HIV prevention priorities and scaling up local prevention initiatives; HIV coordination and harmonization among implementation partners; communication for social change, particularly on norms about AIDS; and the role of civil society in strengthening the HIV response.

UNAIDS Executive Director Dr Peter Piot will give an address at the opening ceremony together with His Excellency the President of the Republic of Uganda, Yoweri Kaguta Museveni, Ambassador Mark Dybul, the U.S. Global AIDS Coordinator/PEPFAR, Dr Michel Kazatchkine, Executive Director of the Global Fund, and Dr. Kevin Moody, CEO of GNP+.

This is the second HIV Implementers’ Meeting, with the first taking place in 2007 in Kigali, Rwanda.

Some 3 million people now have access to antiretroviral therapy according to a report issued today by WHO, UNAIDS and UNICEF. Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector was launched in Geneva by Dr Margaret Chan, WHO Director-General. The report notes that one million people started on treatment last year alone which represents an increase of around 46.5% from the previous year.

“Three million people on treatment is an important milestone and an incredible achievement,” said Elhadj As Sy, Director of Partnerships and External Relations at UNAIDS. “It shows that scale-up is happening and that momentum now needs to be sustained.”

The report findings also show that 2007 saw improved access to drugs to prevent mother to child transmission of HIV, expanded testing and counselling, and greater commitment to male circumcision in some of the more heavily affected regions of sub-Saharan Africa.

The rapid scale-up of treatment has been attributed to a number of factors, including increased availability of drugs, in large part because of price reductions; improved delivery systems; and increased demand as the number of people who are tested and diagnosed with HIV rises.

However the report also warns that despite the rapid scale-up there are an estimated 6.7 million people in need of treatment who are still unable to access the life-saving drugs.

“It is important to note that despite these successes there were 2.5 million new HIV infections last year,” said Peter Ghys, Chief, Epidemiology and Analysis Division, UNAIDS. “If new infections continue at this rate it will be impossible to sustain the treatment scale-up successes we are seeing today.”

Other challenges outlined in the report highlight the obstacles to achieving universal access and the Millennium Development Goals including: weak health systems; a shortage in health workers; a lack of sustainable long term financing and weak information systems.

The report underlines the urgent need for enhanced political commitment, better coordination and additional research to address some of these challenges if the goals that have been set out are to be achieved.

UNAIDS and the government of Brazil signed an agreement on Wednesday 21st of May, 2008 to continue their cooperation on providing technical support to countries in strengthening and scaling-up national responses to AIDS through the International Centre for Technical Cooperation on HIV/AIDS (ICTC).

In 2005, Brazil with support from UNAIDS established the International Centre for Technical Cooperation on HIV/AIDS (ICTC) which has been playing a lead role in promoting technical cooperation on AIDS. The centre has established a network of AIDS service organization and experts in the region who are available to countries in developing and strengthening national responses. The centre has also managed a number of regional and international training programmes to build capacities in low and middle income countries ranging from human rights to the clinical management of HIV infection.

Some of the technical cooperation activities undertaken by the ICTC include strengthening national policies in areas such as HIV prevention and care, epidemiology, monitoring and evaluation, human rights, and the strengthening of civil society. To that end, UNAIDS has supported initiatives such as the organization of a workshop to harmonize public policies for sexual education and prevention of AIDS and drugs in the school environment of six Latin American countries, a workshop on AIDS spending assessment in Latin America, and conducting a meeting to identify the needs for technical cooperation in Latin America.

ICTC has received support from DFID, GTZ, UNFPA, the World Bank and other international partners and the current agreement with UNAIDS will enable the centre to scale up its operations and strengthen the quality and scope of the support it provides.

ICTC's work is based on the principle of horizontality, which recognizes that considerable variation exists among countries in terms of epidemiological profile, country response, organization of health and social services, culture, legal and political systems, and levels of economic, social and technological development. In view of this, ICTC's projects are elaborated jointly with countries and tailored to the specific requirements and resources of each, in accordance with the principles of the 'Three Ones.'

Leaders from Africa, Asia, Europe and other parts of the world are in Yokohama for the 4th Tokyo International Conference on African Development (TICAD). The theme of this year’s meeting is “Towards a vibrant Africa” and will focus on mobilizing knowledge and resources to overcome the obstacles facing Africa as it moves its economy and social development agenda forward.

AIDS will be addressed within a session on human security and achieving the Millennium Development Goals. UNAIDS Executive Director Dr Peter Piot will participate in this joint thematic segment to emphasize the response to AIDS as a key element in efforts to achieve the Goals in Africa, from eradicating extreme poverty to empowering women.

With AIDS remaining as the leading cause of death for African adults, HIV prevention, treatment, care and support services need to be scaled up in the next years if the Goals’ targets are to be met by 2015.

This year’s three-day conference is also being used to announce the laureates of the first Hideyo Noguchi Africa Prize, an award established by the Japanese Government to recognize achievements in the field of health services and medical research in Africa. In health services, the award has been given to Miriam K. Were, a Kenyan doctor and chairperson of Kenya's National AIDS Control Council, for her leadership in supporting the country’s response to AIDS, and in medical research, Dr Brian Greenwood of the United Kingdom, for his innovative work on Malaria.

Before TICAD, Dr Piot participated in a symposium in Tokyo earlier in the week on communicable diseases as threats to human security. He joined several eminent speakers including the Japanese Prime Minister Yasuo Fukuda, Global Fund Executive Director Michel Kazatchkine, and UN Secretary-General’s Special Envoy for AIDS in Africa Elizabeth Mataka. The event was organized by Friends of the Global Fund – Japan.

The opening day of this year’s Eurovision song contest, 18 May, coincided with the 25th International AIDS Candlelight Memorial – a civil society movement for AIDS remembrance, awareness and community action.

To mark the occasion, UNAIDS brought together Eurovision participants in Belgrade to draw attention to the issue of stigma and discrimination against people living with HIV as part of its ‘Stars against AIDS’ project.

The artists chosen to represent Georgia, Bulgaria, Ukraine and Macedonia at this year’s Eurovision joined thousands of people around the world by coming together in solidarity to light candles and remember those who have been affected by AIDS.

“A few years ago I was shocked to learn how pressing the AIDS challenge was in Ukraine,” said Ukranian singer Ani Lorak. “Then I realized that there was no way that I could stay away from the issue and I decided that I had to do everything it takes to help.”

“People living with HIV are just like everyone else. By hugging them and shaking their hands I wanted to demonstrate that AIDS is not transmitted through friendship,” Ani Lorak continued.

The artists attended a press conference with the Deputy Ministry of Health of Serbia and Serbian representatives of the Network of People Living with HIV, to denounce the challenges that people living with HIV face in their everyday life.

“I am proud of this project which has brought together a group of talented singers from across Europe,” said Sergei Furgal, Director, a.i. UNAIDS Regional Support Team for Eastern Europe and Central Asia. “Through their music, songs and their strong personal commitment to improving the lives of youth—I know that they will be compelling and eloquent advocates in focusing attention on HIV and making a difference in the AIDS response.”

The Georgian singer Diana Gurtskaya – one of the main catalysts of the ‘Stars against AIDS’ initiative - spoke of her concern about discrimination against people living with HIV.

“We cannot boost the level of tolerance in society unless we change ourselves, “ said Gurtskaya, “ We should do everything it takes to make sure that people living with HIV can enjoy life just like everyone else.”

The Eurovision Song Contest was first held in 1956 and since then it has become hugely popular media event of truly international scope.

“Like many gay men in Kenya I am married,” said Peter (not his real name) a taxi driver in Nairobi who was busy ferrying partygoers to and from the third party attended by several hundred gay-identifying men and their friends to be held in the Kenyan capital in the last six months.

“We have to hide our sexuality from the rest of society. It’s not like in Europe. But I have a good life, good family, and good friends and really I cannot complain.”

Peter, who has two young children and has always lived in Nairobi, decided to work rather than attend the party held just outside the city centre: “I would have liked to be at the party but we have had fewer visitors to Kenya this year and I need the money. It is fun to be in an environment when you can relax knowing that everyone is the same. There is no way that people can be themselves like that in the bars in town”.

“Sometimes a bar does become popular with a gay crowd but then, a point will come that the bar owner will ask them not to come back because he is afraid of the law and afraid that people might think he is also gay.”

The latest party in the fledgling Nairobi scene was organized on the eve of the International Day against Homophobia. In addition to providing an opportunity for dancing and socializing it also provided space for support groups to distribute HIV prevention information and safer sex packs including condoms and lubricants to a group of men often described by public health officials as ‘hard to reach’.

The following day, the Kenya Human Rights Commission, the International Gay and Lesbian Human Rights Commission and the Gay and Lesbian Community of Kenya booked a half page advertisement in a leading national newspaper promoting the International Day against Homophobia and rights for gay and lesbian people in Kenya.

Despite signs that gay and other men who have sex with men (MSM) are better organized and more visible than ever before in both Kenya and the rest of the continent the words ‘overlooked’ and ‘sidelined’ are currently being used to describe the HIV epidemics that are thriving unchecked among men who have sex with men across sub Saharan Africa.

Research in many African countries indicates higher HIV prevalence among men who have sex with men and higher incidence rates from male to male sexual activity compared to the general population. Furthermore consistently higher levels of infection among men who have sex with men and formidable cultural, social and legal barriers, combined with high levels of stigma and discrimination and the need to address AIDS within the general population, have inhibited the provision of MSM-targeted HIV prevention, care and treatment services.

In order to address this situation, the Kenya National AIDS Control Council co-hosted a meeting with the Population Council in May 2008 to bring together researchers, advocates and national AIDS programme managers from other African countries to review the status of research and evidence around HIV and men who have sex with men in Africa.

Opening the meeting Professor Miriam Were, Chairperson of the Kenya National AIDS Control Council, recognized the many social and cultural challenges involved in addressing the increased HIV risk of male to male sex and encouraged participants to face facts and develop constructive responses to address HIV among men who have sex with men.

Evidence on HIV prevalence, risk and behavior within groups of men who have sex with men was presented from several studies in Kenya and studies from Namibia, Uganda, Tanzania, Nigeria, Malawi and South Africa.

Meeting organizer and Associate with the Population Council, Scott Geibel, said: “In recent years there has been an increase of research focusing on the HIV needs of African men who have sex with men. The research is helping stimulate an increase in programmatic responses. In Kenya we particularly appreciate that the National AIDS Control Council has considered our research results and allowed it to inform their decision and policy making”.

“Through sharing lessons learned with other African National AIDS Programmes we hope to see an acceleration of targeted HIV responses for men who have sex with men in the region.”

In April 2008, the Open Society Institute in Southern Africa (OSISA), OSI’s Sexual Health and Rights Project (SHARP) and John’s Hopkins Bloomberg School of Public Health, hosted a meeting in Cape Town, South Africa, of organizations working on research and advocacy on HIV prevalence among men who have sex with men in Botswana, Namibia, Malawi and South Africa.  

The OSISA/SHARP research partnership was initiated in response to the lack of funding and programmes addressing access to HIV prevention and AIDS treatment services targeting MSM despite overwhelming anecdotal evidence that MSM are a high risk community within the region. 

The meeting was intended to evaluate community based studies, managed by national organizations of men who have sex with men, assessing HIV-related risk behaviors and describing the epidemiology of HIV infection among black MSM in urban sites in the four focus countries.

In addition to revealing higher levels of HIV, other key themes emerging from the various African research projects and initiatives indicate that many men who have sex with men in Africa also have female sexual partners and do not necessarily identify themselves as gay.

In all studies, unprotected receptive anal sex was reported as highest risk for HIV transmission. Reported condom use, although often higher than sexually active heterosexuals, was often inconsistent and remains relatively low.

Andy Seale, Senior Regional Adviser for UNAIDS Regional Support Team East and Southern Africa, said: “Despite strengthening evidence that men who have sex with men are disproportionately affected within the generalized and hyper endemic HIV epidemics of Africa there is still poor targeting within national strategic AIDS plans and through programmes and services.

“Stigma and discrimination, even among AIDS programmers and policy makers, remains a real barrier to scale-up.”

Health Development Networks and SAFAIDS (the Southern Africa AIDS Information Dissemination Service) have been hosting an e-forum among AIDS practitioners in Southern Africa entitled ‘Sidelined in Prevention’ to identify barriers to scale-up.

“The discussion so far has been illuminating – during the first few weeks several postings were made anonymously by people fearful of being associated with work focused on men who have sex with men and those who feel unable to engage with the issue on religious and moral grounds,” said Seale.

The e-forum has mobilized a useful exchange between AIDS practitioners and LGBTI organizations (lesbian, gay, bisexual, transgender and intersex) with the sharing of tools, resources, strategies and approaches including to scaling up targeted prevention at a community level.

“Clearly we still have a long way to go – we need to put aside tensions between public health and rights based approaches and any personal issues around morality. All of us in the region working on AIDS should ensure that all people – regardless of their sexual preferences - are able to access the prevention, care and treatment services they need,” said Seale.