Jorge Sampaio, UN Secretary General's
Special Envoy to Stop TB

Ahead of World TB Day, UNAIDS asks the UN Secretary General’s Special Envoy to Stop TB and former President of Portugal, Dr Jorge Sampaio about his involvement in the fight against TB, its links with HIV and what he sees are the top priorities for HIV/TB collaboration in the future.

1. During the last decade, you have made important contributions to many of the challenges currently facing the international community. What made you passionate about becoming more involved in TB?

For me, health for all is a matter of human rights. Three out of the eight Millennium Development Goals are health-related and include fighting against the three global pandemics, AIDS, tuberculosis and malaria. I’ve been aware of TB all my life because my father was a doctor––but I realized that TB was a major new public health emergency when the MDGs started being discussed around the turn of this century.

2. How do you think your role in politics is helping you to fulfil your new role as Special Envoy to Stop TB?

I am a lawyer by profession and obviously that helps with advocacy, I have also had a long political career (now I am retired!), so I am used to political negotiations and have had a lot of experience in diplomatic and international affairs. In my personal view, political experience is critical because my role as a Special Envoy is not to settle technical questions, but rather to increase political and social support for the TB control policies recommended by WHO and the Stop TB Partnership. My main focus is to persuade world leaders, policy makers, main international, regional and national stakeholders, the media, the private sector, patients, communities and others to secure greater political support for fully funding and implementing the Global Plan to Stop TB.

3. What role do you think the HIV community and UNAIDS can play in implementing the Global Plan to Stop TB?

Jorge Sampaio Met with UNAIDS
Executive Director, Dr Peter Piot
in Geneva earlier this year to
move the agenda forward on TB
control including the HIV/TB co-
epidemic and XDR-TB

One of the main points I always emphasize is the need to stimulate a co ordinated approach to HIV and TB. Together HIV and TB generate a noxious synergy that accelerates each other’s progression and has led to an explosion of TB cases in regions with high HIV prevalence. In order to control TB in high HIV prevalence settings far more effective collaboration between TB and HIV programmes and communities must be implemented.

I do think that the Global Plan to Stop TB and TB programs based on the WHO Stop TB strategy, as well as UNAIDS’ plans for universal access to HIV prevention, treatment, care and support represent an appropriate framework to scale up TB/HIV collaborative efforts. But some gaps remain––particularly in the areas of political and resource commitment to collaborative TB/HIV activities and new tools for prevention, early diagnosis and rapid treatment of TB in people living with HIV.

4. How can we encourage the TB and HIV communities to work more closely together?

Education for health is dramatically needed to counteract stigma and social discrimination surrounding HIV and TB. Communities have to know the basic facts; TB causes at least 11% of total deaths in people living with HIV (this can rise to as much as 60% in some African settings); 750,000 people living with HIV develop TB each year; most TB can be successfully treated even in people living with HIV; untreated, TB will cause death within weeks for people living with HIV; t reatment of TB can prolong and improve the quality of life for HIV-positive people.

5. How do you think we can keep the world interested in TB and HIV, despite competing issues such as global warming, avian flu, terrorism? 

Health is a key dimension of human safety and development, and is a matter of human rights. To realize these very basic rights worldwide, we need to double efforts and avoid working at cross-purposes which delays us unnecessarily.

6. If we are to have a real chance of getting ahead of these epidemics what, in your opinion, are the areas that the world should be focusing on?

UN Secretary-General Ban Ki-moon with
Jorge Sampaio at UN Headquarters in
New York

In my own personal view, four overarching but long overdue issues deserve immediate attention and call for strong extra action by the international community.

First, keeping the fight against TB high on the global agenda, particularly in light of the emerging of multidrug-resistant and extensively drug-resistant TB, which poses a new major public health threat and requires urgent action.

Secondly, improving coordination in the fight against AIDS and TB.

Third, Africa . Africa must be top priority and put at the highest spot on the international agenda––it is not acceptable that it should remain a continent at risk. Sub-Saharan Africa faces the greatest health challenges, with 11% of the world’s population and 24% of the global burden of TB disease, yet only 3% of the world’s health workers.

Fourth, s trengthening health systems––promoting a global plan to strengthen health systems is a key issue in achieving most of the health related MDGs.

Photo credit:StopTB/T.Falise

Tuberculosis (TB) remains a global emergency despite the fact that it is a preventable and curable disease. Chronic lack of investment in TB programmes and research into new ways to diagnose, treat and prevent TB have left us extremely vulnerable to the new, emerging threats to TB control. The discovery of TB that is resistant to almost all drugs (extensively drug resistant TB – XDR TB); the deadly synergy between HIV and TB; and the ageing global population jeopardize the ability of TB control programmes around the world to cope.

World TB Day on 24 th March aims to focus the world’s attention on these and other major challenges that face global TB control. Achieving the TB-focused targets of the United Nations' Millennium Development Goals by 2015 will depend on increased global commitment to TB control, and greater investment in research and the health services that deliver TB services.

Photo credit:StopTB/P.Virot

TB is one of the biggest killers of people living with HIV. At least one third of the 40 million people estimated to be living with HIV around the world are likely to be infected with the TB bacteria and at greatly increased risk of developing TB disease. Up to 80% of TB patients are co-infected with HIV in sub-Saharan Africa. Improved collaboration between TB and HIV programmes will lead to more effective control of TB among people living with HIV and can ensure that HIV positive TB patients get the HIV treatment and care they need.

"The TB and HIV communities can do much more together to address these leading causes of illness and death than they can apart. Much greater collaboration is essential if we are going to reach our common goals of achieving universal access to TB and HIV prevention, diagnostic and treatment services," said Dr Alasdair Reid, HIV/TB Adviser, UNAIDS.

The Global Plan to Stop TB lays out a budgeted plan for what the world needs to do to achieve the TB-focused Millennium Development Goals, including collaborative TB/HIV activities. If fully funded and implemented it will lead to 50 million cases of TB being treated and 14 million lives saved by 2015. However, in its first year the Global Plan is already under-funded.

Photo credit:StopTB/J.Davenport

The plan emphasizes the need for governments of high TB burden countries and donors to increase investment in TB control; greater involvement of affected communities in the response to TB; the need to protect communities from the threat of drug-resistant TB and HIV-related TB; and the need for funding for research into new and effective TB drugs, diagnostics and vaccines.

Ahead of World TB Day, the World Health Organization will release ‘Global TB Control Report’ which outlines the progress on achieving the 2005 global TB control targets. The report will be available on March 22nd at www.who.int/tb.

"Leadership" has been chosen by the World AIDS Campaign as the theme for World AIDS Day 2007 and 2008. This theme will continue to be promoted with the slogan "Stop AIDS. Keep the Promise."—the World AIDS Campaign (WAC) emphasis from 2005-2010.

On December 1 every year, the world comes together to commemorate World AIDS Day. The theme for World AIDS Day has been determined by the World AIDS Campaign since 1997.

“We know that significant advances in the response to HIV have been achieved when there is strong and committed leadership. Leaders are distinguished by their action, innovation and vision; their personal example and engagement of others; and their perseverance in the face of obstacles and challenges,” said the World AIDS Campaign. “Leadership must be demonstrated at every level to get ahead of the epidemic- in families, in communities, in countries and internationally.”

“Much of the best leadership on AIDS has been demonstrated within civil society organisations challenging the status quo. Making leadership the theme of the next two World AIDS Days will help encourage leadership on AIDS within all levels and sectors of society,” the Campaign added.

The 2007/8 theme of “Leadership” will build on the 2006 World AIDS Day focus on accountability, and was selected by the Global Steering Committee of the World AIDS Campaign during their meeting held in Geneva in February.

“We are still dying! Leadership requires that we face this reality. While scaling up of HIV care is now prioritized, it is under funded and poorly implemented,” said WAC Steering Committee Member and Chairperson, Global Network of People Living with HIV/AIDS Deloris Dockrey.

“Leadership can imply the power and authority to make a difference, to lead by action and example,” added fellow Steering Committee member and Coordinator for the Ecumenical Advocacy Alliance, Linda Hartke. “By taking on the global theme of leadership for World AIDS Day, faith leaders and the communities they are a part of can help articulate a vision, build relationships and take concrete action in solidarity with all people committed to reaching universal access for HIV prevention, treatment and care.”

The overall purpose of the World AIDS Campaign from 2005 to 2010 is to ensure that leaders and decision makers deliver on their promises on AIDS, including the provision of Universal Access to Treatment, Care, Support and Prevention services by 2010. Within that five-year mission, annual campaigning themes are selected which are timely, relevant and adaptable to a number of different regions and issues.

The issue of continued and increased leadership on AIDS and it’s importance to a long-term sustainable AIDS response was underlined by UNAIDS Executive Director Peter Piot at the European AIDS Conference held in Bremen, Germany on 12-13 March. “ Leadership makes or breaks the response against AIDS,” he said.

The Global Steering Committee of World AIDS Campaign is comprised of the Global Network of People Living with HIV/AIDS, the International Community of Women Living with HIV/AIDS, the Youth Coalition, the Global Unions Programme on HIV/AIDS, the International Council of AIDS Service Organisations, the Ecumenical Advocacy Alliance, and the International Women’s AIDS Caucus. UNAIDS and the Global Fund to Fight AIDS, TB and Malaria are non-voting members.

Tatiana Semikop’s story begins in 1994 when she was working as a criminal police officer in Odesa. That was the year Tatiana met an 11-year-old boy living with HIV who did not know who or where to turn to for help and support. At the time Tatiana knew very little about AIDS but wanted to help the boy, so she set out to learn more and to find out how he could get support. However, the more Tatiana looked, the more she realized there was little available.

“I was shocked,” said Tatiana. “I couldn’t believe that no-one in the oblast or even the city could give me the information I was looking for, no-one seemed to know anything, it was as if the disease didn’t exist,” she added.

Finding out more

During her efforts to find out more about AIDS, Tatiana heard about a workshop being organized by UNAIDS to provide on HIV prevention for law enforcement groups. Through this workshop she gained vital knowledge on the complex issues related to AIDS in Ukraine and the different kinds of interventions needed in the country to help stem the spread of the disease.

Ukraine is facing the most severe AIDS epidemic in Europe. At the end of 2005, nearly 400,000 people were living with HIV in Ukraine and adult HIV prevalence was estimated at over 1.4%. Ukraine’s epidemic is primarily concentrated among people considered to be most ‘at-risk’—and 60% of the people living with HIV inject drugs.

“Using non-sterile injecting equipment is the major driver of the AIDS epidemic in Ukraine,” said Anna Shakarishvili, UNAIDS Country Coordinator in Ukraine. “More than 45% of new HIV infections reported in the first half of 2006 were in people who inject drugs. But sexual transmission of the infection from drug users is also rapidly increasing and the number of children born to HIV positive mothers continues to rise,” she added.

Unprecedented approach

Through her police work, Tatiana encountered injecting drug users on a regular basis and to her it made sense to start focusing her HIV prevention work here. With her help, Ukraine’s first projects to reduce harm from injecting drug use were initiated and implemented.

A unique feature of the programmes was the cooperation with the law enforcement groups and an agreement by Odesa’s Mayor to say these activities could take place—a groundbreaking move for the country at that time.

“We couldn’t believe that we had really dared to take such an unprecedented and unique approach to tackling the epidemic,” said one of the seven members of the small team who started the pilot project. “This had never been done before in Ukraine,” she added.

From these modest beginnings, today there are programmes focusing on injecting drug users and HIV across Ukraine which have become commonly recognized and respected HIV prevention tools.

Twelve years later

Twelve years since first encountering the issue of AIDS, Tatiana Semikop has moved up to the ranks of police lieutenant-colonel, is an author of a scientific dissertation on the psychological characteristics of police work relating to AIDS, and is the Chairwoman of one of the most efficient non-governmental HIV-service organizations in Ukraine – Vera, Nadezhda, Lubov (“Faith, Hope and Love”). In March this year Tatiana Semikop received her second ‘Woman of the Year’ award from law enforcement groups in Odesa for her continued commitment and dedication to the AIDS response.

Inspired by their mother’s example, Tatiana’s children have followed in her footsteps. Her 16-year old daughter Nina, gives lectures on AIDS at her secondary school, participates in various projects and writes articles on AIDS for a city newspaper. Her 24 year-old son Evgeny has already become a coordinator of one of the HIV-service projects in Odesa.

Vera, Nadezhda, Lubov

Tatiana’s organization Vera, Nadezhda, Lubov provides a variety of services across Odesa and neighbouring districts –-including a special mobile voluntary counselling and testing outlet that tests female sex workers for HIV and sexually transmitted infections at the site of their work; and helps women who have suffered domestic violence.

The organization has more than 100 members and provides information services and training on AIDS and other related issues at educational institutions around the city and in the rural areas. Vera, Nadezhda, Lubov also publishes a newspaper for people who inject drugs, sex workers and people living with HIV.

Tatiana is particularly proud of the creation of a community centre for people living with HIV and people most at risk of HIV infection. “We organise nature trips, holidays and we have special visiting photo exhibitions, a self help group and a social club,” she said.

Working on AIDS issues has become a source of inspiration for Tatiana and her colleagues. Many of the organization’s employees have personal experiences of drug addiction and came to know about the organization when seeking support. Now, having received training and professional experience, they have become indispensable employees, committed to helping others going through similar life situations.

“The explanation for our success is very simple,” said Tatiana. “We believe in what we are doing, and we see the fruit of our efforts every day.”

Links:

Read more on Ukraine
Read more on the European AIDS Conference: Responsibility and Partnership – Together against HIV/AIDS 

Photo credit:UNAIDS/ICC

Amidst celebrations at the opening of the ICC Cricket World Cup in the Caribbean on Sunday 11 March, players and spectators around the world were asked to reflect on the lives of children and young people living with and affected by HIV in the region.

The message came as part of joint efforts between the International Cricket Council (ICC), UNAIDS, UNICEF and the Caribbean Broadcast Media Partnership on HIV/AIDS (CMBP) to draw attention to the issues facing children and young people affected by HIV and to highlight the need to step-up action on AIDS in the region.

The Cricket World Cup is the highlight of the cricketing year. More than two billion television viewers are expected to tune in over the next seven weeks to watch 16 teams battle it out for a place in the World Cup final, to be held in Barbados on 28 April.

AIDS-awareness activities

Through a number of activities to be held over the next seven weeks, the public, especially young people aged 15-24, will get information on stigma and discrimination around HIV and on how to protect themselves against the virus. The partnership is part of the ICC’s commitment to promoting the ‘Spirit of Cricket’ and its positive impact on society and its commitment to support the Unite for Children, Unite against AIDS campaign launched in 2005 by UNICEF, UNAIDS and other partners.

“The spirit of cricket is a special part of our game and is a concept that stretches beyond the boundaries of the outfield,” said ICC President Percy Sonn. “We hope the range of activities delivered at the ICC Cricket World Cup 2007 will make a difference to raising awareness and reducing stigma around HIV in the Caribbean and across the ever-growing cricket world,” he added.

A series of video messages supporting the Unite for Children. Unite against AIDS campaign by 28 of the world’s top cricketers, including Australian captain Ricky Ponting and Indian captain Rahul Dravid, will be broadcast on TV and at the matches.

Photo credit:UNAIDS/ICC

Players and officials from each team will wear the red and blue campaign ribbon during their first games and during the final. Players will also visit programmes in the Caribbean supporting children and young people affected by HIV.

As part of the events around the World Cup, the Caribbean Broadcast Media Partnership on HIV/AIDS – a coalition of over 50 broadcasters in 23 Caribbean countries and territories – is also launching the region’s first media-led, multi-platform campaign on HIV/AIDS, known as LIVE UP! The campaign aims to inspire the people of the Caribbean, especially young people, to consider what they can do to stem the spread of HIV.

"The exceptional reach of broadcast media in the Caribbean gives us a unique opportunity to educate audiences about how to avoid HIV, and how to combat the stigma and discrimination that surround the disease," noted CBMP Steering Committee Chair Allyson Leacock. "By doing what we do best, communicating with our neighbours, members of the CBMP are helping our audience to remain healthy and well-informed, while we all work together to reduce the impact of HIV in our region."

Sport – a force for change

Cricket is popular in many of the countries that are most impacted by AIDS, including India and South Africa. Together, these two countries are home to around 11 million of the 40 million people living with HIV worldwide.

In the Caribbean, UNAIDS estimated that 250,000 people – 15,000 of whom were children under the age of 15 – were living with HIV in 2006.

“Young people today have never known a world without AIDS. Sports stars – such as top cricket players – can act as role models for today’s young generation and reach out to them on AIDS issues,” said UNAIDS Executive Director Dr. Peter Piot. “Sport is a force for change that can break down barriers, build self-esteem and teach life skills and social behaviour. By highlighting AIDS issues, the ICC Cricket World Cup and its cricketing stars are showing exactly the kind of exceptional response needed for the exceptional challenge of AIDS.”

Representatives of 27 European Union and neighbouring countries met in Bremen, Germany to discuss ways of strengthening political leadership in the response to AIDS. Over 600 people attended the conference which was organised by the German Federal Government as part of its 2007 European Union Presidency. UNAIDS Executive Director Dr Peter Piot spoke on the opening day about the epidemic in the region and actions necessary to curb the epidemic. The second day of the Conference included workshops covering many key aspects of the AIDS response in the region including presentations on human rights, migration, stigma, gender and issues concerning sex work, injecting drug use and men who have sex with men.

UNAIDS Executive Director, Dr.Peter Piot talks to Ms. Angela Merkel, Chancellor of the Federal Republic of Germany at the 2007 European AIDS Conference in Bremen, Germany, 12-13 March 2007.

Ms. Angela Merkel, Chancellor of the Federal Republic of Germany during her speech at the 2007 European AIDS Conference in Bremen, Germany, 12-13 March 2007.

UNAIDS Executive Director, Dr. Peter Piot during his speech at the 2007 European AIDS Conference in Bremen, Germany, 12-13 March 2007

Ms. Ulla Schmitt, Germany's Federal Minister of Health at the closing press conference of the European AIDS Conference in Bremen, Germany. 12-13 March 2007

UNAIDS Executive Director, Dr. Peter Piot visiting the UNAIDS stand with Her Highness Begum Aga Khan and Germany's Federal Minister of Health, Ms. Ulla Schmitt at the 2007 European AIDS Conference in Bremen, Germany. 12-13 March 2007.

UNAIDS Executive Director, Dr. Peter Piot met with the Ukranian Minister of Health, Mr. Yuyi Poliachenko at the 2007 European AIDS Conference in Bremen, Germany. 12-13 March 2007

Mr. Kevin De Cock, Director of the department of HIV/AIDS at the World Health Organisation at a workshop on the role of the European Union and the European States in the world-wide fight against AIDS, during the 2007 European AIDS Conference. 12-13 March 2007

Ms. Sophia Kistling, Director of the International Labour Organisation's programme on AIDS at a workshop on the role of the European Union and the European States in the world-wide fight against AIDS, during the 2007 European AIDS Conference. 12-13 March 2007

Ms. Nina Ferencic, UNICEF's Regional Advisor for AIDS in Central and Eastern Europe at a workshop on cross-border cooperation in Europe during the 2007 European AIDS Conference in Bremen, Germany. 12-13 March 2007

Ms. Dorothee Eckertz, World Bank Operations officer, speaking on lessons learned in harm reduction in the wider european neighbourhood at a workshop on human rights during the 2007 European AIDS Conference.

All photo credit: N.Wolff

UNAIDS Executive Director Dr. Peter Piot with Ms. Angela Merkel,
Chancellor of the Federal Republic of Germany

The northern city of Bremen is the setting chosen by the German Federal Government to host the conference of the German Presidency of the Council of the European Union: “Responsibility and Partnership – Together Against HIV/AIDS”.

Germany has convened the conference as part of efforts to fulfil its pledge of making AIDS its top health priority during Germany’s European Union Presidency in 2007. The German Government has recently reaffirmed this commitment by announcing 400 Million Euros in 2007 for its action plan on AIDS.

The conference, taking place from 12-13 March, is expected to attract over 600 people from around Europe including ministers and representatives from 27 European and neighbouring countries. German Federal Chancellor, Dr Angela Merkel will give the keynote address and UNAIDS Executive Director Dr Peter Piot will speak on the opening day about the epidemic in the region and actions necessary to curb the epidemic.

The conference comes as a follow-up to the 2004 meetings in Dublin and Vilnius where groundbreaking declarations to step up political action on AIDS were signed by participating European ministers.

The second day of the Conference will comprise of workshops covering many key aspects of the AIDS response in the region including presentations on human rights, migration, stigma, gender and issues concerning sex work, injecting drug use and men who have sex with men.

UNAIDS Executive Director Dr. Peter Piot with Germany's
Federal Minister of Health, Ms. Ulla Schmitt

At the close of the conference the attending ministers of health are expected to sign a declaration reaffirming the commitments made in Dublin and Vilnius in a bid to increasing political leadership on AIDS on national, regional and international levels.

UNAIDS is currently coordinating a review of the 2004 meetings which the German Ministry of health is supporting financially, having recently announced 400,000 Euros for initiation of the project.

“ Germany is a valued partner of UNAIDS,” said Bertil Lindblad, UNAIDS Regional Director for Europe. “This is an important year for Germany as holders of both the EU and G8 Presidencies and its commitment to making AIDS its top health priority is not only a commendable decision but a truly necessary one.”

During a visit to Bangkok, Thailand, UNAIDS Executive Director Dr Peter Piot met with the Prime Minister of Thailand and celebrated the International Women’s Day with the Executive Secretary of United Nations Economic and Social Commission for Asia and the Pacific and with Ms. Joana Merlin-Scholtes, the United Nations Resident Coordinator and UNDP Resident Representative in Thailand.

Dr Piot also released a statement stressing the importance of addressing gender inequality and the feminization of the AIDS epidemics. “Women, inside and outside the home, must have the economic, social and political power to stand up for their rights and protect themselves and their families from violence and disease.” He also stated that “to stop the feminization of the epidemic, as well as the epidemic itself, we have to initiate legal but also social, cultural and economic changes to challenge some of the most pervasive social patterns and gender norms that continue to fuel the AIDS epidemic.”

UNAIDS Executive Director, Dr.Peter Piot during his meeting with General Surayud Chulanont, Prime Minister of Thailand at the Government House (Thai koo Fah building). 8 March 2007

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UNAIDS Executive Director, Dr. Peter Piot talks to Ms. Joana Merlin-Scholtes, UN Resident Coordinator Thailand at the United Nations Conference Centre, Bangkok, Thailand during the International Women's Day, 8 March 2007

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From L to R: Ms. Joana Merlin-Scholtes, UN Resident Coordinator and UNDP Resident Representative in Thailand, Dr. Peter Piot, Executive Director UNAIDS and Mr. Kim Hak-Su, UN Under Secretary General and Executive Secretary UNESCAP during the International Women's Day 2007 held at the United Nations Conference Centre, Bangkok, Thailand. 8 March 2007.

Mr. Kim Hak-Su, UN Under Secretary General and Executive Secretary UNESCAP during his opening statement for the International Women's Day 2007, at the United Nations Conference Centre, Bangkok, Thailand. 8 March 2007

UNAIDS Executive Director, Dr. Peter Piot during his intervention for the International Women's Day 2007, at the United Nations Conference Centre, Bangkok, Thailand. 8 March 2007

Ms. Thelma Kay, Director of the Division of Emerging Social Issues, UNESCAP during the International Women's Day 2007 event held at the United Nations Conference Centre, Bangkok, Thailand on 8 March 2007

Ms. Jean D'Cunha, Regional Programme Director of UNIFEM (East and Southeast Asia) during the ceremony held at the United Nations Conference Centre, Bangkok, Thailand for the International Women's Day 2007. 8 March 2007.

All photo credit at United Nations Conference Centre: Daniel Tshin

Links:
Read UNAIDS Executive Director's statement - Addressing gender and AIDS: a compulsory requirement

Purnima is a renowned social scientist and an expert in gender issues in international health, especially in AIDS. Purnima worked for over 12 years as an Associate Professor at the Tata Institute of Social Sciences, Mumbai, India before she joined the Global Programme on AIDS at the World Health Organization in Geneva in 1994. At UNAIDS, she pioneered work on gender and AIDS and managed the Executive Office until 1999. After working for the Population Council in New York in 1999 and the Global Fund to fight AIDS, Tuberculosis and Malaria, Purnima returned to UNAIDS in 2004 as Director of Policy, Evidence and Partnerships. She has co-authored and edited four books including one of the first books on social and cultural aspects of AIDS in India and is a founder-editor of the journal, Culture, Health and Sexuality. On International Women’s Day, Purnima reminds us how women are more vulnerable to HIV and how violence against women increases their vulnerability.

Dear Purnima, today is International Women’s day. Can you tell us how and why women are particularly affected by the AIDS epidemic?

Women represent almost half of people living with HIV. According to the latest data available, 17.7 million adult women are now living with HIV. This is more than ever before and the trends suggest that this number is on the rise. Everyday, 7000 women become infected with HIV. The expression “feminization of the epidemic” does not nearly catch the enormity of the situation…Nearly 25 years into the epidemic, gender inequality remains one of the major drivers of HIV. Yet current AIDS responses do not, on the whole, tackle the social, cultural and economic factors that make women more vulnerable to HIV, and that unduly burden them with the epidemic’s consequences. Women and girls have less access to education and HIV information, tend not to enjoy equality in marriage and sexual relations, and remain the primary caretakers of family and community members suffering from AIDS-related illnesses. When infected with HIV, women are more likely to be deprived of treatment and more likely to face discrimination . To be more effective, AIDS responses must address the factors that continue to put women at risk.

What would be in your opinion, the top priority intervention to reduce women’s risk to HIV?

'No one solution is obviously enough but if I had to choose one, I'd say education is critical. Sending all girls to school and making sure that they complete high school must become a collective top priority. With each additional year of education, girls acquire vital life skills and higher income-earning potential. Girls who complete secondary education know more about HIV – both how to prevent infection and what to do if they think they are infected. They tend to have fewer sexual partners over a lifetime and are more likely to use condoms. And by providing women with more economic options and independence, education gives them vital knowledge, skills, and opportunities. This means they can make informed choices about delaying marriage and childbearing, having healthier babies and avoiding risky behaviour – as well as knowing more about their rights.

The theme of this year’s International Women’s Day is Ending Impunity for Violence Against Women can you tell us more about the issue?

Violence against women continues to be a common, yet widely ignored phenomenon that robs women worldwide of their health, well-being and lives. In many places, violence against women and HIV risk are intertwined.

The most prevalent forms of violence against women are perpetrated by their intimate partners. A staggering 40–60% of women surveyed in Bangladesh, Ethiopia, Peru, Samoa, Thailand and United Republic of Tanzania said they had been physically and/or sexually abused by their partners. Laws for protecting women from such abuse are either lacking, too weak or too poorly enforced to make much of a difference. Social norms in many countries condone domestic violence as a private, even normal matter—leaving millions of women without hope of legal recourse. But there is nothing natural or inevitable about violence against women. Attitudes can and must be changed.

How does violence against women increase risk of HIV infection?

Violence against women is often associated with a heightened risk of HIV infection. Studies in South Africa and Tanzania show that women who have been subjected to violence are up to three times more likely to be HIV-infected than women who have not experienced violence.

Violence—even the fear of violence—also prevents many women and girls from learning or disclosing their HIV status, or accessing essential AIDS services. In Cambodia, the fear of domestic violence appears to be one of the reasons why unexpectedly low numbers of women have been using HIV counselling and testing services at some antenatal clinics. At a clinic in Zambia, some 60% of women eligible for free antiretroviral treatment opted out of treatment, partly because they feared violence and abandonment if they were to disclose their HIV status to their partners. Fear of violence also prevents women from demanding protection or negotiating safer sex.

What is happening to help reduce violence against women?

Promising initiatives are under way to help reduce violence against women. Some, like Stepping Stones, now active in almost 30 countries, and Men as Partners in South Africa, use community-based workshops to challenge gender stereotypes and reshape power relations. Others, such as the Gender Violence Recovery Center in Kenya and the Cambodian Women’s Crisis Center, provide shelters, medical services and counselling, including HIV services or referrals, to women who have experienced domestic violence and sexual abuse. Such efforts must be expanded, supported and incorporated into national AIDS strategies. Governments the world over have committed to eliminate violence against women. It’s time to do more.

What are immediate measures that would help reduce violence against women and reduce their risk to HIV?

Governments must enact and enforce laws that prevent violence against women. In parallel, they must also develop strategies and approaches to ensure that those who uphold the law—civil servants, police, judiciary, healthcare workers, social services etc.—implement it in fact, and to support the victims of violence. We must also develop and fund community-based programmes to help change social norms that condone violence against women and perpetuate its acceptability. This includes educating women, men, boys and community leaders about the rights of women, and the need to change menacing norms of masculinity.

We must also work to expand women’s access to support services and economic resources so that they can escape and recover from abusive and life threatening relationships.

It’s important that national AIDS plans integrate strategies to reduce violence against women, and link violence prevention efforts with mainstream HIV prevention and treatment services.

Links:

View feature documentary "Women are 2… Finding Solutions"

Experts from across the world are gathering this week in Montreux in Switzerland to review the results of recent trials establishing that male circumcision reduces by almost 60% the risk of men to acquire HIV during vaginal sex. These results announced in December 2006 and detailed in recent publications in The Lancet sparked interest and debate in the world of HIV. Is male circumcision as significant an advance as some of its proponents have claimed?

Dr Kim Dickson, from the HIV Department of the World Health Organization is a recognized and respected figure in the field of reproductive health and HIV. She currently coordinates the joint WHO/UNAIDS working group on male circumcision and HIV prevention as well as the Inter-agency Task Team on male circumcision and HIV prevention. She has kindly agreed to tell us more about the meeting and its expected outcomes.

Unaids.org: Dr Dickson, you coordinate the joint WHO/UNAIDS working group on male circumcision and HIV prevention. Can you tell us why WHO and UNAIDS are convening this meeting on male circumcision?

KD: When the US National Institutes of Health decided, in December 2006, to stop the two trials they were funding in Kenya and Uganda on male circumcision and HIV, it became clear that we needed to assess male circumcision as a potential public health intervention in the response to AIDS. The trials, as detailed in the results recently published in The Lancet, confirmed many previous observational studies which suggested that male circumcision significantly reduced the risk of men in acquiring HIV during vaginal sex.

It was important that the World Health Organization and the Joint United Nations Program on HIV/AIDS review the research results and consider what they mean for HIV prevention policy and programming in countries. It was decided to convene a meeting to bring around the table as many stakeholders as possible to look at and discuss many of the issues that male circumcision can raise, and, if possible, give guidance and recommendations for Member States and other stakeholders.

Unaids.org: How many participants are joining in this meeting and what do they represent?

KD: We invited the trials' investigators to present their methodology and their results. We also invited other scientists, from different disciplines such as social science, human rights and communications to ask the investigators questions which were not necessarily in the scope of their trials. We also have 16 representatives from Member States, and 11 from the civil society, including women’s health advocates and a representative from the Global Network of People Living with HIV, to present their own reading of the results and also to raise the issues that they face in their countries and in the context of their activities.

We paid special attention to invite people representing different positions. Last, but not least, we also have eight funding agencies and six implementing partners joining in the discussions. Overall, we are expecting almost 80 participants in Montreux. No need to say that we expect intense discussions that will touch upon many difficult issues.

Unaids.org: What do you expect as the outcomes of this meeting?

KD: The first and immediate outcome resides in the debate that is going to take place this week. This is the first time ever that such a wide range of stakeholders exchange views and discusses the consequences of male circumcision as an additional prevention method in the response to AIDS. At this stage, we cannot pre-empt the outcome. Maybe we will conclude the meeting with more questions than we began with- though I am hoping that at least some questions will be answered and that we will be able to make some recommendations.

The meeting will also identify what we need to do next in order to move forward. In any case, there will be a meeting report which we will make public shortly after the meeting.

Finally, I want to emphasize again and again that our objective is to examine male circumcision as an additional prevention method which should always be part of a comprehensive package which includes, among other elements, the correct and consistent use of male and female condoms, the delay in sexual debut and the reduction of sexual partners. The meeting will discuss how we can strengthen our communications so as not to undermine other prevention methods if we are to scale up male circumcision services.

If the United Nations moves forward with guidance to countries on male circumcision as a public health intervention for HIV prevention, it will be promoted as an ‘additional’ intervention to current HIV prevention packages; not as an alternative. People must understand that male circumcision does not provide complete prevention and they should be encouraged to use more than one of the prevention choices available to them.