In a new report released on HIV prevention, AIDS
experts estimate that expanded HIV prevention
could avert 30 million HIV infections by 2015.
Credit: UNAIDS

AIDS experts estimate expanded HIV prevention could avert 30 million HIV infections by 2015.

In a new report released on HIV prevention, a panel of leading AIDS experts calls for a major increase in global HIV prevention programs, citing new projections that expanded access to prevention could avert approximately 30 million of the 60 million HIV infections expected to occur by 2015.

The report, released by the Global HIV Prevention Working Group, warns that HIV prevention efforts are not keeping pace with the gains being made in treating people infected with HIV. For every person who began antiretroviral therapy in 2006, the report says, six people were newly infected.

“We need to make the same gains in HIV prevention that we are making in HIV treatment,” said Helene Gayle, President and CEO of CARE USA and co-chair of the Working Group. “We have a critical window of opportunity over the next 10 years to dramatically slow the rate of new infections, and ultimately reverse the epidemic.”

For every person who began antiretroviral therapy
in 2006, the report says, six people were newly
infected. Credit: UNAIDS 

“It’s widely assumed that HIV continues to spread because prevention isn’t effective, and that’s simply not true. The problem is that effective prevention isn’t reaching the people who need it,” said David Serwadda, Director of the Institute of Public Health at Makerere University in Uganda, and co-chair of the Working Group.

The report, titled Bringing HIV Prevention to Scale: An Urgent Global Priority, finds that scientifically proven HIV prevention programs – such as those to reduce the risk of mother-to-child HIV transmission – are not being implemented on a sufficient scale, meaning they do not reach enough people, with enough intensity, to curb the epidemic. The report recommends that global spending on AIDS double over the next three years, and calls on governments and donors to ensure that resources are spent on proven prevention strategies targeted to people at highest risk.

Better allocation of resources

Although annual global spending on AIDS has increased six-fold since 2001, it is still only half of what UNAIDS recommends is needed. The Working Group calls for global AIDS spending to double within three years, from the current level of US$10 billion annually to the UNAIDS target of $22 billion by 2010, and for approximately half of this spending to be allocated for prevention, as UNAIDS recommends.

“Over the past few years there have been major increases in funding for AIDS, but we are still well short of what is needed,” said Nicholas Hellmann, interim Director of the HIV and TB programs at the Gates Foundation and a member of the Working Group. “Increasing spending now will save both lives and money over the long term.”

HIV prevention programs need to be designed for
people at highest risk of HIV infection.
Credit: UNAIDS

The report notes that as AIDS spending increases, it is critical for governments and international donors to ensure resources are used strategically. For example, a number of countries focus prevention efforts on general HIV awareness campaigns even though the vast majority of new infections in those countries are occurring among specific high-risk groups such as men who have sex with men and commercial sex workers. Donors should also remove any politically-based funding restrictions that limit access to scientifically proven and evidence informed HIV prevention strategies.

“Knowing the dynamics of your own HIV epidemic, and how the last 1000 infections have been transmitted, is key to tailoring HIV prevention strategies to really benefit those most in need,” said Catherine Hankins, UNAIDS Chief Scientific Advisor and Steering Committee member of the Working Group.

The Working Group is an international panel of more than 50 leading public health experts, clinicians, researchers, and people living with HIV. It is co-convened by the Henry J. Kaiser Family Foundation and the Bill & Melinda Gates Foundation.

Links:

Download the full report of the Global HIV Prevention Working Group
More information on the Working Group
More on HIV prevention

International politicians seeking guidance on how to better prevent and treat HIV joined community health workers in Brazil as they made their house calls. 

As part of the activities of the newly-set up Inter-Parliamentary (IPU) advisory group on HIV/ AIDS, parliamentarians from India, Uganda, South Africa and Sweden chose to visit Brazil for their first field trip, given the country’s reputation for best practice on AIDS issues. Access to free health care is written into Brazil’s constitution and the energetic, multisectoral AIDS response has made a real impact on the epidemic.

By not focusing specifically on HIV the health workers create an atmosphere of confidentiality and understanding.

By not focusing specifically on HIV the health
workers created an atmosphere of confidentiality
and understanding.

In Sao Paulo, community health teams learn how to introduce the subjects of contraception and HIV prevention as part of general discussions on health. They then make regular door-to-door visits in low income neighbourhoods.  

“What impressed me about the Brazilian approach is ensuring that universal access to free health care is enshrined in their constitution, Being able to provide the same standards of care to all citizens irrespective of their status in society is something to emulate,” said Dr Elidoa Tumwesigye,” head of Uganda’s Parliamentary Committee on HIV/AIDS.

“Everyone was impressed. By not focusing specifically on HIV the healthworkers created an atmosphere of confidentiality and understanding - this made it easier for people to come forward and seek further information about their HIV status,” said James Jennings of the IPU.

The visit was organised by the Brazilian Congress International Advisory, supported by the Brazilian National AIDS Programme, UNAIDS and UNDP. The IPU group also met the Minister of Health Jose Gomes Temporao and attended a special debate organised by the parliamentary committee on social welfare and the family.   

“This mission happens in a strategic moment, in which all efforts are intensifying to guarantee the universal access to HIV prevention, treatment, care and support 2010. The participation of legislators is essential and Brazil has an important experience to share on this theme” said Luiz Loures, UNAIDS Associate Director for Global Initiatives.  

In Brazil, 50 Parliamentarians from across the political divide have formed the “Parliamentary Front for Health.” They work together to ensure AIDS is kept high on the political agenda and to break down prejudice and stigma.

Legislators in the AIDS response 

The global objective of the Inter-Parliamentary Union (IPU) advisory group on HIV/AIDS is to learn how different legislatures approach the subject of HIV. Politicians within the group aim to learn from each other’s experience in different contexts and settings.  

“In some countries it’s not even acceptable to talk about it. You can’t legislate about something if you can’t even discuss it,” Mr Jennings pointed out.

Politicians within the Inter-Parliamentary Union advisory group on HIV/AIDS aim to learn from each other’s experience in different contexts and settings.

Politicians within the Inter-Parliamentary Union
advisory group on HIV/AIDS aim to learn from each
other’s experience in different contexts and settings.

Marco Aurélio da Silva from the National Network of People living with HIV/AIDS (RNP+ Brazil) called on parliamentarians to increase their active participation in the AIDS response. 

“The inclusion of legislators in AIDS debates and their participation is very welcome. This partnership is extremely important”.    

For example, he said that most people living with HIV were on social security. “We need the intervention of legislators in order to guarantee our ability to remain at work”.  

A new edition of a handbook on HIV for legislators will be launched at the first IPU Global Parliamentary Conference on HIV to be held in Manila in November, just before World AIDS Day.  

“The full engagement of parliaments in their respective countries is crucial to ensure the appropriate responses to AIDS and secure the necessary resources to support them”, said Eduardo Barbosa, Deputy Director of the National AIDS Programme in Brazil, who was actively involved in the organization of the Brazilian IPU visit.

UNAIDS and UNICEF Special Representative Her
Royal Highness Princess Mathilde of Belgium
joined the symbolic tree planting event led by
organisations of people living with HIV in China.

Two issues of global importance, AIDS and the environment, were highlighted during a symbolic tree planting event led by organisations of people living with HIV in China.

The event, organized by the Beijing Health Bureau in collaboration with local HIV advocacy groups, the Mangrove Support Group and Ark of Love organization, forms part of a year-long initiative to greater involve people living with HIV in important public events, highlighting their contribution to Chinese society and in particular to the city of Beijing prior to its hosting of the 2008 Olympic Games.

"With more publicity about AIDS, more and more people living with HIV are facing up to the reality and taking active steps to have a fulfilling life in society," said Meng Lin, the founder of the "Ark of Love" organization.

Under the title “ Olympics with you and me", Mangrove Support Group first started the tree planting project in 2006 by leasing the land near the Olympic construction site and arranging a number of trips to this area for people living with HIV and various organizations involved in the AIDS response. During these events, trees are planted and watered and small personal name plates are tied to the trees.

The project activities not only provide an opportunity for people living with HIV to help make Beijing greener but also aim to reduce AIDS-related stigma and discrimination.

UNAIDS and UNICEF Special Representatives HRH Princess Mathilde of Belgium and Serge Dumont, Senior Vice President of the Omnicom Group also joined the awareness raising initiative.

Her Royal Highness Princess Mathilde of Belgium
talks with Ms. Guan Baoying, Deputy Director,
Disease Control Division, Beijing Health Bureau
(middle) and a member of a local HIV advocacy
group during the tree planting event .

In her speech at the event, Her Royal Highness Princess Mathilde stressed the importance of acceptance and inclusion of people living with HIV in Chinese society. “The universal values of the Olympic spirit -- Unity, Friendship, Progress, Harmony, Participation and Dream—are the very values that should guide us in all our contacts with others, whatever their age, sex, ethnic origin or HIV-status,” she said.

Applauding the tree-planting initiative, Her Royal Highness Princess Mathilde underlined: “You are showing us the way, working together to make Beijing greener for the well-being of all.”

Also participating in the event were Ms. Jiang Yiman, Executive Vice President of China Red Cross, Ms. Deng Yaping, Red Cross Goodwill Ambassador, table tennis player and winner of six world championships and four Olympic gold medals, as well as Dr. Mukesh Kapila, Special Representative on HIV of International Federation of Red Cross and Red Crescent Societies, and leaders from the United Nations, Ministry of Health, the Chinese Olympic Committee and the Global Business Coalition on AIDS, TB and Malaria.

In China an e stimated 650,000 people are living with HIV. Approximately 30,000 people living with HIV currently receive anti-retroviral treatment.

The new national plan was developed through a
highly inclusive participatory process, including a
wide array of Indian non-governmental
organizations as well as community based groups.

“India has a prime opportunity to drive its AIDS response forward and get ahead of its epidemic,” said UNAIDS Deputy Executive Director, Michel Sidibe, commenting on the successful development of the country’s National AIDS Control Plan III. Currently waiting final sign off from the Indian Ministry of Health, the plan is widely recognized by national stakeholders and international development partners as being the ‘best’ national AIDS strategic plan that India has had.

“With the new plan, India has the potential to set an example for the rest of the world,” Sidibe said during a mission to the country to take stock of UNAIDS work in the country and to identify a strategy for UNAIDS, towards supporting the government, national stakeholders and development partners achieve the goals of the national plan.

With particular focus on scaling up investment on prevention activities among high risk populations, and increasing antiretroviral treatment coverage, the plan emphasizes critical involvement of community based organizations and institutions both in public and private sectors as key to its success. Creation of appropriate mechanisms and capacities at national, state and district levels to implement and monitor the interventions are also central to the plan.

With a budget of $US 2.5 billion for the next five years, the new national plan was developed through a highly inclusive participatory process, including a wide array of Indian non-governmental organizations as well as community based groups. The importance of state level action and a decentralized AIDS response is also a critical element of the plan.

“It is crucial now that all partners sustain this positive energy and momentum in the period of implementing the plan,” said Sidibe, underlining that UNAIDS would work hard to sustain commitment to action on AIDS in India, and to support implementation further through the provision of high quality, timely strategic information to all stakeholders in India.

A panel chaired by UNICEF’s Director of Programmes Alan Court discussed the missing faces of children in planning AIDS treatment programmes.

Three years ago, it was difficult to find data on children and HIV. There were several reasons for this, namely denial, stigma, many mothers’ fears of disclosing their HIV status, lack of support from fathers, and medical staff showing little concern for the welfare of the children.

From 2003, as the missing face of children became a rallying point for advocacy, research was conducted which confirmed that children had been hit hard by the AIDS epidemic and were receiving little support.

Countries such as Rwanda have shown tremendous political commitment to support children affected by the AIDS epidemic. Community mobilisation efforts to ensure that mothers are aware of and have access to the services available for children are paying off. However, fathers remain the missing link. The panellists agreed that the pressures to protect children weigh heavily on mothers. The father is often absent and, in many cases women receive such little support from their husbands that they fear disclosing their status.

This point was brought home by the testimony of a young HIV positive mother, who said she had been a virgin up to the time she married but found herself infected and widowed just fourteen months into her marriage. She said that had it not been for the HIV support group, she wouldn’t have been able to cope.

She said that disclosing one’s HIV status was an important step to ensuring that both adults and children get access to much needed support. Preserving and strengthening family ties for families affected by AIDS can go a long way to helping ensure that children are properly cared for by their parents. The session called upon all implementers to ensure the needs of children are prominent in all HIV programming and interventions.

With HIV-related tuberculosis (TB) cases increasing in many parts of Africa, Dr Chakaya Muhwa highlighted the work of the Kenyan government to establish clear policy guidelines and effective organizational structures. These have come at a time when TB is emerging as a serious public health problem in Kenya, compounded by the appearance of drug-resistant TB strains that are making the disease that much more difficult and expensive to treat.

In his presentation, “TB/HIV: Integration of Services and Stopping the Newest Epidemic” Dr Chakaya said TB and HIV programmes should work together because the link between the two diseases was clear. He emphasised the importance of treating all illnesses associated with HIV and the need to improve health care systems. He also flagged the need to base human resource needs on staffing norms, not on workload assessment. He also stressed the need to recognise best practice in adequately controlling HIV and TB infections. “Inadequate infection control practices encourage the transmission of HIV and TB,” he said. TB control programmes needed to be strengthened and better coordinated with HIV programmes.

As part of efforts to prevent transmission of HIV from new mothers to their babies, South Africa has set up a programme called “Mothers to Mothers” (m2m). As part of the programme, women are trained to mentor other pregnant women and new mothers living with HIV. Mr Gene Falk explained that Mothers to Mothers was proving to be an effective, sustainable model of care. The women can also use a telephone hotline which has been an important channel of conveying education and support. Public education through TV shows also proved to be one of the most effective ways of informing women about mother-to-child transmission of HIV.

In Zambia there are over 16 % of adults aged 15-49 are living with HIV. Dr. Namwinga Chintu from Zambia’s Center for Infectious Research said that follow up to identify infants who’d been exposed to HIV, was a priority. She added that in Zambia, initiatives aimed at preventing mother to child transmission of HIV had been increased thanks to collaboration between the Zambian government and partners backed by the US government. In a country where the AIDS epidemic has had a devastating impact on all facets of Zambian life, she said that co-operation between government and partners involved in the AIDS response was crucial. She called for innovative funding programmes to help prevent mother to child transmission of HIV and for the implementation of methods that support government ownership.

“A little push in the right direction can make a big difference,” she said

She cited many challenges in implementing HIV programmes, including competing health priorities, how to deliver services to hard-to-reach areas and the poor rates of facility deliveries.

Ensuring that HIV information is securely stored and
confidentiality maintained will avoid potential
stigmatization and discrimination of individuals and
communities. Photo credit: UNAIDS/A.Gutman

In middle-and lower-income countries there is a push to improve patient management and the monitoring and evaluation of HIV services. To do this, all information systems, either paper-based or electronic, need to allow for relatively easy access to information. To ensure that patient confidentially is not compromised in the process, new guidelines have been released.

The ‘Interim Guidelines on Protecting the Confidentiality and Security of HIV Information’ offer information on data transfer, guiding principles, even disposal of information all to help maintain patient confidentiality.

Developed through a special workshop supported by UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), international health professionals and people living with HIV reviewed existing materials that could then be adapted to middle- and lower-income countries.

“Good clinical information is required for optimum treatment and care for people living with HIV.” said Eddy Beck, Senior Technical Officer, UNAIDS Evaluation Department. “Ensuring this information is securely stored and confidentiality maintained will avoid potential stigmatization and discrimination of individuals and communities, and enhance the quality of the information collected,” he added.

The new guidelines provide definitions, guiding principles and technical recommendations for the maintenance of privacy, confidentiality and security in working with HIV-related information.

The main recommendations from the guidelines:

Using health data for public health goals must be
balanced against individuals’ rights to privacy and
confidentiality. Photo credit: UNAIDS/A.Gutman

• Using health data for public health goals must be balanced against individuals’ rights to privacy and confidentiality;
• Health data need to serve the improvement of health and reduction of harm for all people. Policies, procedures, and technical methods must be balanced to protect both;
• individual and public rights must be balanced, and should be based on human rights principles;
• Within countries, privacy and confidentiality laws should be developed and put in place; relevant parameters of privacy or confidentiality laws must be reviewed and known by all persons accessing health data;
• The development and review of laws and procedures related to HIV information needs active participation from relevant stakeholders, including people living with and affected by HIV, health care professionals, and legal and ethical experts;
• Funding organizations should comply with these guidelines and make funding available to implement them. Maintaining security and confidentiality must be a condition for funding.

These interim guidelines will be field tested and additional training materials will be developed.

Conflict and displacement make refugees highly
vulnerable to the risk of HIV. Photo credit: UNAIDS

As UNHCR announces that the number of refugees has increased for the first time since 2002, AIDS remains a key challenge for growing displaced populations.

Displacement of people has an enormous effect on their lives, as well as upon the lives of host communities.

Conflict and displacement make refugees highly vulnerable to the risk of HIV.  As refugees struggle to meet their basic needs such as food, water and shelter, women and girls are often forced to exchange sexual services for money, food or protection. And too often refugees are excluded from national AIDS initiatives and policies and subsequently do not have access to vital HIV prevention and treatment services.

Access to basic HIV-related care and support for refugees is also rarely given adequate attention. For women and girls in particular, conflict and displacement heighten their vulnerability to the risk of HIV. During conflict, rape is often used as a weapon of war. Women and girls are also often subject to sexual violence and exploitation in refugee settings.

A policy brief developed by UNAIDS and the UN High Commission on Refugees (UNHCR) focuses specifically on actions required to prevent HIV and mitigate the effect of HIV on refugees and their host communities.

The policy brief focuses on emergency and post-emergency phases and suggests actions for governments, civil society and international partners in order to ensure that refugee and human rights laws are applied, and that the needs of refugees are included into national HIV policies and programmes.