UNAIDS Executive Director Dr Peter Piot giving the
2007 Payne Lecture at Stanford University on May 9.

“AIDS is forcing us to adopt new approaches, look at things differently, and transform the way we do things,” said UNAIDS Executive Director Peter Piot as he gave the 2007 Payne Lecture at Stanford University on May 9.

In remarks punctuated with statistics, Piot reflected on how the epidemic and its response have evolved and how AIDS is changing the world. He also outlined some of the key challenges ahead for sustaining the AIDS response in the long-term.

“We are still in the middle of a crisis. Eight thousand people are dying every single day from AIDS,” he said.

The UNAIDS Executive Director stressed that AIDS has turned into one of the most serious challenges our planet has ever faced, ranking with climate change, international terrorism, and the threat of nuclear war as “one of the defining issues of our time.”

He outlined how major progress has been made on many fronts, including decreasing rates of infection and increasing levels of antiretroviral medicine. And, he underlined, AIDS has become an agent for social change—for example, contributing to the gay rights movement by increasing awareness and leading to a healthy and more open consideration of sexuality and gender roles.

Dr Piot outlined how major progress has been made
on many fronts, including decreasing rates of
infection and increasing levels of antiretroviral
medicine.

Nevertheless, he stressed, much remains to be done.

“The truth is that after 25, 26 years since AIDS was discovered, the end of this epidemic is nowhere in sight. AIDS is both a global problem and a multi-generational problem ,” he said.

“We need young people in the fight against AIDS because it is not going to be over tomorrow,” he added.

Roughly 65 million people have been infected with HIV since 1981. What started as a disease associated with middle-class gay men is now a universal problem.

“There are countries in southern Africa where 30-40% percent of the adults are HIV-positive,” Piot said. “Just imagine what that would be in California — 10, 20 million people living with HIV.”

Numbers like these are especially devastating countries with failing health systems, he said. He also noted that the epidemic is spreading alarmingly quickly in the former Soviet Union and India.

“ AIDS does to society what HIV does to the human body — it weakens the immune system just as it weakens the resiliency in a society,” he said. “It weakens the ability to cope and to deal with difficult things.”

Dr Piot spoke of a “brilliant alliance” that would
combine the efforts of politicians, big business, trade
unions and religious institutions to combat the
disease.

He added that as an exceptional disease, AIDS requires an exceptional response and outlined a number of challenges ahead including increasing and sustaining political commitment and funding, ensuring the money available reaches the people who need it most, advancing scientific developments and addressing the fundamental drivers of the AIDS epidemic – such as gender inequality and violence against women, stigma and discrimination, and the marginalization of homosexuals, drug users, and migrants.

“There is enormous stigma and discrimination attached to the disease, and that’s what makes it so unique,” Piot said. “It’s about sex and drugs; that’s what makes it so difficult to address.”

Piot spoke of a “brilliant alliance” that would combine the efforts of politicians, big business, trade unions and religious institutions to combat the disease. “ We need the brightest and most creative minds to defeat this epidemic,” he said.

Fewer than 8% of injecting drug sers receive HIV
prevention services

Injecting drug use is estimated to account for nearly one-third of new infections outside sub-Saharan Africa, but fewer than 8% of injecting drug users receive HIV prevention services. 

Drug users not only face physical risks of HIV infection, they are also vulnerable to HIV because of their social and legal status. Illegal in many countries, drug use is punishable by incarceration and is highly stigmatized, which further marginalizes people with drug dependence problems. As a consequence, injecting drug users are often not able or willing to access HIV services for fear of recrimination.

This month’s UNAIDS Best Practice review features several HIV prevention programmes that prove ‘high coverage site’ programmes reaching out to more than 50% of the injecting drug user populations with focused prevention interventions, can prevent, stabilize and even reverse HIV epidemics among injecting drug users.

“The scaling up of HIV prevention and even more so care and treatment for drug users is lagging behind in the overall AIDS response. The current HIV prevention coverage rate of 8% shows the problem,” said Anindya Chatterjee, UNAIDS Advisor on Prevention and Public Policy. “We know that focused HIV prevention programmers have been successful in reducing HIV prevalence among people who inject drugs . In countries and cities where harm reduction programmes have been implemented early and on a large scale, HIV prevention programmes have been successful––down to less than 5% in some cases,” he said

The Best Practice shows that ‘High coverage site’
programmes reaching out to more than 50% of the
injecting drug user populations  with focused
prevention interventions, can prevent, stabilize and
even reverse HIV epidemics among injecting drug
users.

The document, entitled ‘High Coverage Sites: HIV prevention among injecting drug users in transitional

and developing countries’ was developed from a report first commissioned by UNAIDS to investigate sites in developing and transitional countries which were regarded by international authorities as “high coverage sites” i.e. where more than 50% of injecting drug users had been reached by one or more HIV prevention programmes. In all, seven sites were examined, including Soligorsk, Belarus; Pskov, Russian Federation; Sumy, Ukraine; Dhaka, Bangladesh; Rajshahi, Bangladesh; Hong Kong Special Administrative Region (Hong Kong SAR), People’s Republic of China and Salvador, Brazil.

Found to prove that high-level coverage can be attained by programmes specifically addressing HIV among injecting drug users, the report later became part of the UNAIDS ‘Best Practice Collection’ .

Common features of high coverage programmes

As the Best Practice document underlines, effective approaches to addressing HIV among injecting drug users are controversial in many parts of the world. Therefore, across the programmes featured, substantial work was devoted to overcoming community fears and government concerns about the initiatives. This was generally achieved through advocacy at many levels, starting with the community in the immediate neighbourhood where services were provided, through formal and informal meetings, public information campaigns, involvement by programme managers in multi-sectoral AIDS and drugs committees and, in most cases, by carefully building relationships with selected representatives from the mass media.

In one example highlighted, a joint media campaign organized by the Department of Health, the Narcotics Division of the Security Bureau and the Information Services Department of the Hong Kong Special Administrative Region Government was carried out in 2002 through TV, radio and web to increase public understanding of drugs and AIDS-related issues and the role of methadone, aiming to change public attitudes towards drug users and methadone clients.

Across the featured programmes, regular evaluations and dissemination of results assisted in building political and community support. In some cases, political support resulted in laws and policies, which provided for HIV-specific services, and government funding to ensure programme implementation. “Sustainability is most likely in sites where this type of political commitment exists,” the Best Practice states.

Central to all the featured programmes in the document, the involvement of law enforcement services was a critical determinant for the success of the programmes and crucial in achieving high coverage of injecting drug users. “Programme clients needed to be able to attend needle exchange sites, or methadone or HIV treatment clinics without fear of arrest and outreach workers carrying new and used needles and syringes needed to be able to work without supplies being confiscated,” the report states.

The Best Practice also underlines the importance of
 involving injecting drug users as programme staff to
 achieve high level coverage and sustainability of
the programmes.

In most of the sites studied, law enforcement services entered into flexible and trust-based working relationships with programme staff, and even participated as full partners in planning and expanding the programmes. The programme manager at the Soligorsk site in Belarus said, “Relations with police are excellent and this has made a real difference— for example, the regular patrol route was altered so that police vehicles were less likely to pass the Programme at the Centre for Hygiene and Epidemiology during its opening hours, meaning drug users were more inclined to attend.”

The Best Practice also underlines the importance of involving injecting drug users as programme staff to achieve high level coverage and sustainability of the programmes. An important factor in the initial growth of the programme in Pskov, Russian Federation was hiring an active injecting drug user as an outreach worker. Without this involvement, the document states, it would have been impossible to establish relations with the injecting drug user community as several previous attempts had been made by the AIDS Centre staff with no results. Here and in other examples, establishing strong and trusting relations with drug users was key to accessing injecting drug user networks.

In the example from Salvador, Brazil, the programme aims at addressing drug using neighbourhoods rather than just drug users individually. This approach means that a wide range of services have been established to form a comprehensive set of drug and HIV-prevention activities as well as general health and social assistance. While the main objective is to provide services to injecting drug users, crack cocaine smokers and other non-injecting drug users, services also reach out to their families, sexual partners, neighbours and other people living in drug-using neighbourhoods.

The report underlines that success may not be
immediate and this means that funding for such
programmes needs to be solid, flexible and
sustainable.

Across all the examples within the Best Practice document it is underlined that the programmes are unique to the social, political and cultural settings in which they are implemented.”Rather than replicate models developed by other countries, programme planners and implementers studied the principles underlying programmes and designed appropriate HIV programmes for their sites,” the report states.

However, the report underlines that success may not be immediate–indeed, none of the programmes described achieved high level coverage in the first year of operation—and this means that funding for such programmes needs to be solid, flexible and sustainable. “Funding should not only be flexible enough to allow for growth in service use; a commitment is also needed for at least two years to ensure that programmes reach sufficient numbers of injecting drug users,” notes the report.

Taking into consideration the many challenges faced by the programmes, the Best practice concludes that the coverage achieved through the focused interventions has led to the avoidance or delay of AIDS epidemics among injecting drug users in a number of the countries.. In Bangladesh; Hong Kong SAR; Pskov, Russian Federation; and Sumy, Ukraine, high HIV prevalence among injecting drug users has been avoided despite high prevalence in neighbouring provinces or countries with similar cultures and levels of injecting drug use.

“The best practice case studies show that achieving a high coverage among drug users is highly possible and both HIV prevention and treatment programmes for drug users need dramatic scaling up,” said Anindya Chatterjee.

The President of Côte d’Ivoire, His Excellency
Laurent Gbagbo (middle), is leading the drive to
mobilize resources for the implementation of the
county’s national AIDS plan.

The President of Côte d’Ivoire, His Excellency Laurent Gbagbo, is leading the drive to mobilize resources for the implementation of the county’s national AIDS plan.

At a roundtable meeting held in Abidjan at the beginning of May, President Laurent Gbagbo and Prime Minister Guillaume Soro welcomed members of the Government, heads of key departments of the public and private sector, civil society groups including networks of people living with HIV, religious leaders and non-governmental organizations to discuss strategy and action to ensure full funding for the implementation of the 2006-2010 National Strategic Plan. High–level representative of the United Nations system and development partners, and the Director of the UNAIDS Regional Support Team for West and Central Africa also attended on the invitation of the Government of Côte d’Ivoire. 

The 2006-2010 National Strategic Plan contains clear targets for scaling up towards universal access to HIV prevention, treatment, care and support. It was developed in collaboration with a number of partners and its total cost amounts to US$577 million.

In addition to domestic funding for AIDS from the government itself, financial and technical support for AIDS in Cote d’Ivoire is provided by the President’s Emergency Fund for AIDS Relief (PEPFAR), the Global Fund, the World Bank and the UN system.

The 2006-2010 National Strategic Plan contains
clear targets for scaling up towards universal access
to HIV prevention, treatment, care and support.

Addressing participants of the roundtable meeting, the President and the Prime Minister emphasized AIDS as “the major challenge for the country’s development” and called for extensive social mobilization and the involvement of all sectors, particularly the civil society and the networks of people living with HIV. They also stressed the important role of public/private partnerships in the national response.

The leaders appealed to partners to harmonize approaches and to strengthen support, especially at this crucial post conflict period, while committing themselves to ensure transparency and accountability with regard to resources management.

The UNAIDS Director of the Regional Support Team for West and Central Africa Dr Bekele Grunitzky had an audience with the President in the presence of the Minister in charge of AIDS the representatives of WFP, UNICEF, WHO and the UNAIDS Country Coordinator. Speaking on behalf of UNAIDS Executive Director Dr Peter Piot, Dr Bekele Grunitzky expressed thanks and appreciation to President Gbagbo and his government for maintaining their commitment to address AIDS. “We congratulate the President and the country on the progress made towards peace, a prerequisite for the development of the country and the scaling up of the AIDS response,” she said.

“We also applaud the government for their evident commitment and leadership on AIDS. UNAIDS and its cosponsors are fully committed to support Côte d’Ivoire throughout the implementation of the National Strategic Plan,” she added.

An estimated 750,000 people are living with HIV in Côte d’Ivoire, over half of whom are women over the age of 15 (400,000). At the end of 2005, HIV prevalence among adults aged 15 – 49 stood at 7.1%.

The HIV and AIDS and STI Strategic Plan for South
Africa, 2007 – 2011 details concrete targets to be
reached in specific areas by 2011. Photo credit:
UNAIDS/E.Miller

The AIDS response in South Africa has been given a boost with the successful endorsement of two key processes: the restructured South African National AIDS Council (SANAC) and a new national AIDS plan which will guide South Africa’s response to AIDS over the next five years.

The revamped Council is a high-level multi-sectoral partnership body chaired by South Africa’s Deputy President, Phumzile Mlambo-Ngcuka, with a civil society representative to be elected as the deputy chair. The Council comprises government ministers and leaders from 18 civil society sectors and it will play a leadership role ensuring consensus is built on and maintained on issues of AIDS-related policy and strategy. The Council will also oversee the overall implementation and review of the new National Strategic Plan.

Heralded as South Africa’s most dynamic and comprehensive document on AIDS issues yet, the HIV and AIDS and STI Strategic Plan for South Africa, 2007 – 2011 draws on lessons learned from the country’s response to AIDS over the past decades and details concrete targets to be reached in specific areas by 2011.

On May 2, the South African Cabinet officially endorsed the five-year plan. Key to the development of the plan has been the extensive participatory and consultative process that started in 2006 and involved government officials, a wide range of civil society organizations, the United Nations, academic and research institutions, labour and business.

The primary aims of the plan are to cut the number
of new HIV infections by 50% and reduce the impact
of HIV by expanding access to appropriate treatment,
care and support to 80% of all people diagnosed
with HIV. Photo credit: UNAIDS/G.Pirozzi

The primary aims of the plan are to cut the number of new HIV infections by 50% and reduce the impact of HIV by expanding access to appropriate treatment, care and support to 80% of all people diagnosed with HIV. The plan also pledges to reduce the rates of mother-to-child transmission of HIV to less than 5% and to allocate 40% of the projected budget towards HIV treatment.

Mark Heywood, of the AIDS Law Project and Treatment Action Campaign and member of the UNAIDS Human Rights Reference Group, who was involved in the drafting of the document, said he believed it was a "serious and bold" plan. “Its recognition of the centrality of human rights is very important and it provides much-needed targets concerning treatment and HIV prevention, as well as clearly assigned responsibilities for making the plan a reality,” he said.

“This process brought the South African government closer to civil society and has given us, as a nation, the opportunity to find each other and recommit ourselves to fighting the spread of HIV,” said Member of Parliament Hendrietta Bogopane-Zulu, representative for the disability sector within the National AIDS Council and member of the Task Team of national AIDS experts appointed by the Director General of the Department of Health to lead the finalization of the national plan. “It was a collective effort and I believe it will be a collective effort once again as we implement the plan. The plan shows us that today is better than yesterday and tomorrow will be even better,” she said.

At the end of 2006, one in nine or 5.5 million South
Africans were living with HIV, with a prevalence of
18.8% in the adult population. Photo credit:
UNAIDS/P.Virot

Throughout the development of both processes, UNAIDS worked closely with the National AIDS Council and the South African Department of Health. Through the Joint UN Team on AIDS, UNAIDS provided technical support to several civil society consultations during the development process.

“Supporting these processes has been a priority for UNAIDS in assisting South Africa to drive its response forward. We welcome the new and bold leadership in strengthening the AIDS Council and developing the solid national plan. The extensive reaching out to, sharing with and learning from civil society and other partners underlines the movement towards a unified national response to the epidemic,” said UNAIDS Country Coordinator Mbulawa Mugabe who was also a member of the 16-member Task Team.

“Critical now is the timely and effective implementation of the plan, which UNAIDS and the UN family will be supporting as much as we can to make the goals laid out a reality for South Africa,” he said.

At the end of 2006, one in nine or 5.5 million South Africans were living with HIV, with a prevalence of 18.8% in the adult population. HIV prevalence is not yet declining although it has stabilized among young people 15-24 years. National HIV prevalence among pregnant women at Antenatal Clinics was 30.2% in 2005.

In June South Africa will hold the 3rd National AIDS Conference with the theme: Building Consensus on HIV Prevention, Treatment and Care. The conference aims to serve as a platform for deliberations on the key contentious issues relating to HIV prevention, treatment and care. UNAIDS Executive Director Peter Piot will open the National Conference.

According to the Internal Displacement Monitoring Centre of the
Norwegian Refugee Council, there are some 24.5 million
conflict-related IDP’s in at least 52 countries around the world.
Photo credit: UNHCR/H.Coussidis

The first global consultation on HIV and internally displaced people took place in Geneva from 24 to 25 April, bringing together some 45 experts from governments, United Nations agencies, non-governmental organizations and the academic world.

The global consultation, convened by one of UNAIDS’ Cosponsoring organisations the United Nations High Commission for Refugees (UNHCR), was the first of its kind to be held specifically to address the effects of HIV on internally displaced populations (IDP’s).

"This is a neglected area where the needs are great but we frankly don't know enough about the various situations," says Paul Spiegel, head of United Nations High Commission for Refugees (UNHCR) HIV unit. "This is only the beginning of a process which, hopefully, will help us identify gaps, plan joint programmes and improve services for IDPs."

Like refugees, internally displaced persons are civilians who have been victims of violence, persecution or human rights violations, or who have been forced out of their homes by conflict. But, unlike refugees, IDPs remain in their own country.

“Even in the absence of large amounts of data, there is no doubt that internally displaced people are a unique group with special HIV needs,” said Elhadj As Sy, Director of Communications and External Relations at UNAIDS. “Many will have suffered from trauma and violence, including sexual violence, during conflict. Some remain anonymous for various reasons including, security concerns, making their access to HIV services difficult.”

Displaced people, however, are not necessarily more vulnerable to HIV infection, says Spiegel. "In the case of refugees, people at first believed that they had higher HIV prevalence than host communities, but this proved not to be the case. We need to do more research on the effects of displacement on HIV infection."

Colombia , Côte d'Ivoire, the Democratic Republic of the Congo, Myanmar, Nepal and Uganda were highlighted during the consultation along with some eastern European countries.

"It is not possible to have a single approach to all these situations. The situation in each country, and sometimes even in each region within a country, is completely different," said Spiegel. "We hope that we will learn from the different experiences of those attending the consultations. We need everybody to become involved. We need everybody's help."

The consultation was held to raise awareness and result in more effective joint advocacy and programming, as well as in more research on HIV and IDP issues.

According to the Internal Displacement Monitoring Centre of the Norwegian Refugee Council, there are some 24.5 million conflict-related IDP’s in at least 52 countries around the world. Between 70 and 80 percent of them are women and children. The countries with the largest internally displaced populations are Sudan, Colombia, Iraq, Uganda and the Democratic Republic of the Congo.

Under the general umbrella of the Office of the UN emergency relief coordinator, UNHCR has been given the lead role in overseeing the protection and shelter needs of IDPs as well as the coordination and management of camps. Other UN agencies have adopted similar roles in the areas of water, nutrition, health, logistics and telecommunications.

This story first appeared on the UNHCR website on the 24 April 2007. UNHCR strives to ensure that refugees live in dignity, free from discrimination, regardless of their HIV status, and to provide at least the core HIV/AIDS interventions during emergencies.

Links:

The involvement and participation of communities in providing care and support to people living with HIV and orphans in Swaziland has been heralded as a prime example of ‘best practice’ within the AIDS response that should be further developed across the country.

Mr Thembo Absalom Dlamini, The Right
Honerable Prime Minister of the Kingdom
of Swaziland

At a meeting with the Prime Minister of the Kingdom of Swaziland, Mr Themba Absalom Dlamini, UNAIDS Executive Director Peter Piot applauded the excellent examples in Swaziland where decentralization of the AIDS response using local community structures has helped reach the people most in need and at risk. He encouraged Swaziland to build on these experiences to ensure future successes.

According to latest estimates, Swaziland now has the highest adult HIV prevalence in the world – 33.4%.
“Swaziland is a country facing extreme challenges, with high HIV prevalence levels—but the country has shown that by decentralizing the response, more people can be reached and engaged, with the community becoming a central force of the response,” said Dr Piot.

Commending the Prime Minister on his leadership of the national AIDS response and spearheading the National Action Plan on AIDS, Dr Piot encouraged continued leadership and action, particularly in the area of scaling up HIV prevention to halt new infections in the country. Dr Piot underlined that “the whole nation” should be engaged in a sustained social movement to intensify HIV prevention, addressing the drivers of the epidemic in Swaziland and moving towards the country’s targets for universal access to HIV prevention, treatment, care and support.

There is a need to intensify HIV prevention to halt growing
infection rates and sustain the gains that have already been
made in the AIDS response. Photo credit: UNAIDS/G.Pirozzi 

Although a small number of countries around the world have seen HIV prevalence decline due to sound HIV prevention efforts, in 2006, there were still 4.3 million new HIV infections with over 40% of new adult infections occurring among young people aged 15-24.

These figures underline a clear and urgent need to intensify HIV prevention to halt growing infection rates and sustain the gains that have already been made in the AIDS response if the commitment to achieve universal access to HIV prevention, treatment, care and support by 2010 is to be met

As part of the ongoing efforts to identify effective HIV prevention interventions, UNAIDS in collaboration with the Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS) and the Health and Development Networks (HDN) is launching a new regional electronic discussion forum entitled “Accelerating Prevention”.

The electronic discussion forum (e-forum) aims to create a platform for people in eastern and southern Africa to share knowledge, experiences and skills in prevention, as well as to promote advocacy, partnerships and networking at both national and sub-regional level.

“For SAfAIDS, the ‘Accelerating Prevention’ e-forum will provide an opportunity and a platform for civil society to express their concerns, thoughts and experiences about HIV prevention. It is important for all to lend their voice to the debate and make a difference,” said Lois Chingandu, Executive Director, SAfAIDS

“Accelerating Prevention” is a time-limited e-forum that will run for a period of six months, starting on Monday 30 April until October 2007. During this period, six main topics related to prevention will be discussed, one each month, supported by position papers written by experts in HIV prevention issues which will serve as starting points for the electronic discussion. The six main topics for discussion will be:

1. Key drivers of the epidemic

2. Role of men in HIV prevention (including the issue of male circumcision)

3. Prevention for young people

4. Role of ‘classical’ sexually transmitted infections (STI) treatment in HIV prevention

5. Prevention from the perspective of people living with HIV

6. Strategic condom programming

Each topic will be broken down into key questions to guide the discussions. Research and resources will be collected in a database to support and supplement the discussion while key resource people will be identified for each topic.

By targeting stakeholders in eastern and southern Africa, the “Accelerating Prevention” e-forum discusses pertinent HIV prevention issues that will inform programme design and implementation across the region. Recognizing that there is no ‘one’ solution to bringing down rates of HIV infection, and that prevention programming needs will differ from country to country, and within a country itself, the forum emphasizes strategic information that can be used to guide programming to reach people most at risk and most in need.

“This e-forum provides a virtual space for the region to critically analyse the risk factors and drivers of the epidemic. It is hoped that the discussions will provide innovative and concrete suggestions of ways in which our HIV prevention interventions can be strengthened so that we can begin to reduce the number of new HIV infections in the future,” said Mark Stirling, Director of the UNAIDS Regional Support Team, East and Southern Africa.

UNAIDS’ Deputy Executive Director Debbie Landey
with Kemal Dervis, Administrator of UNDP, at the
meeting in Brazzaville.

UNAIDS’ Deputy Executive Director Debbie Landey was in Brazzaville recently to attend a meeting on ‘ Africa’s agenda in a reforming United Nations system’. The meeting, convened by the United Nations Development Programme (UNDP), was held to discuss progress on ‘Delivering as One’ and to take UN Reform forward at country level. Participants included all of the UN Resident Coordinators from sub-Saharan Africa, Dr Asha-Rose Migiro, United Nations Deputy Secretary-General, Kemal Dervis, Administrator of UNDP and Gilbert Houngbo, UNDP’s Regional Director for Africa.

Ms Landey chaired a panel discussion on country expectations for increased effectiveness with high level representatives from pilot countries who volunteered for the ‘Delivering as One’ pilot initiative. Representatives included; Ms Monique Nsanzabanganwa, Minister of State in charge of Economic Planning of Rwanda; Antonio Lima, Conseiller spécial du Président du Cap Vert; Enrique Banze, Vice-Minister of Foreign Affairs, Mozambique; Mrs Joyce Mapunjo, Deputy Permanent Secretary in the Ministry of Planning, Economy and Empowerment and Chair of the Technical Committee of the 'One UN' initiative in Tanzania; and Jim Drummond, Director, UN Humanitarian, Conflict and Security Affairs, DFID.

During her visit, Ms. Landey met with the Minister of
Health, Family and Social Affairs of the Republic of
Congo-Brazzaville, Emilienne Raoul

Together with participants, the high level representatives of the pilot countries reviewed the very high expectations they have from UN increased effectiveness in their countries.

Ms Landey also participated in a panel on challenges and opportunities for the UN system on ‘Delivering as One’.

Ms Landey shared the experience of UNAIDS by outlining it’s efforts to reinforce national leadership and structures; the principles of the ‘Three Ones’, bringing policy coherence to the response, reforming the architecture of the international response through the work of the Global Task Team, and bringing operational coherence on the ground through joint programming, joint teams, and the division of labour.

UNAIDS’ Deputy Executive Director Debbie Landey
met with the UN Country Team to discuss the national
response to AIDS.

“The experience of UNAIDS has much to offer to the ongoing broader efforts to bring greater coherence to the work of the UN system in support of country lead development goals and objectives,” said Ms Landey.

During her visit, Ms. Landey also met with the Minister of Health, Family and Social Affairs of the Republic of Congo-Brazzaville, Emilienne Raoul as well as with the UN Country Team to discuss the national response to AIDS, including the efforts of the government to put in place enhanced coordination mechanisms, update the data on the epidemic and set targets for universal access to HIV prevention, treatment, care and support .

More than 4,000 people participated in the four-day
forum that came to a close on 20 April 2007 in
Buenos Aires.

The IV Latin American and Caribbean Forum on HIV/AIDS and STD’s came to a close on 20 April 2007 in Buenos Aires. More than 4,000 people participated in the four-day forum where people living with HIV, civil society groups, non-governmental and governmental institutions, academia, media and UN agency representatives came together to share ideas and discuss challenges and opportunities in the response to AIDS and sexually transmitted diseases in the region.

“This forum has been instrumental in increasing the visibility of the AIDS epidemic in the region,” said Dr. Cesar A. Nunez, UNAIDS Regional Director for Latin America.

Dr. Karen Sealey UNAIDS Regional Director for Caribbean added, “During this forum Governments, civil society and strategic partners have been called upon to continue unifying efforts and resources in the response to HIV in the region.”

Dr. Cesar Nunez, UNAIDS Regional
Director for Latin America
highlighted the role of the forum in
increasing the visibility of the AIDS
epidemic in the region.

The International Centre for Technical Cooperation on HIV/AIDS (ICTC) a joint Brazil/UNAIDS initiative played a key role in organizing satellite sessions and side meetings focusing on commitment to providing technical assistance to countries and civil society groups in the region. The event also provided the setting for a meeting of the Coalition of First Ladies and Leader Women on AIDS.

Argentina ’s Minister of Health, Dr. Ginés González García and Dr. Mirta Roses, Director of the Pan American Health Organization underlined their commitment to overcome the challenges in the response to AIDS during their speeches at the closing ceremony.

“ Argentina will continue working with the countries of the region in finding the best prices for the drugs needed in order to improve access to treatment,” said Dr. González García. “Only these actions will help achieve the goals we have for the upcoming years,” he added.

Dr. Roses, speaking on behalf of the United Nations agencies said, “HIV has to be taken to the highest point in the political agenda, if not, our response will be too late. Poverty and social inequities relating to gender and ethnic groups need to be addressed as issues that are fuelling the AIDS epidemic in our region.”

The forum has been an excellent platform
 to share ideas and discuss challenges in
the response to AIDS in the region.

One of the important considerations at the forum was the discussion around the topical issue of male circumcision as an additional HIV prevention tool. Participants were united in recommending that male circumcision should not be seen as a stand alone prevention method and that it should only be considered and recommended as part of a comprehensive prevention package which should include correct and consistent use of condoms and a reduction in the number of sexual partners.

The forum is a bi annual initiative of the Horizontal Group of Technical Cooperation. It´s organising committee includes representatives of the regional civil society networks: ICW LATINA, REDTRASEX, ASICAL, REDLA+, MLCM+, REDLARD, LACASSO, REDLACTRANS.

The main outcomes included;

• Strengthening HIV prevention and promoting sexual health
• Ensuring that human rights for children and young people are integrated into the HIV response in the region
• Increasing HIV prevention programmes for people at higher risk of HIV infection including; men who have sex with men, sex workers, transpopulations, prisoners and people who inject drugs
• Generating public policies that guarantee gender identity and the reduction of stigma, as well as policies on human rights vulnerabilities such as poverty, ethnic groups and gender
• Strengthening the inclusion and participation of women in the response to the epidemic
• Promoting the monitoring and evaluation of access to treatment
• Reinforcing epidemiological surveillance and including civil society in the processes
• Setting targets towards the 2010 goal of universal access
• Ensuring adequate strategic planning, the will to ensure the mobilization of funds for implementation and successful monitoring and evaluation in countries

During the closing session, Andrés Leibovich, President of Foro 2007, made a symbolic transfer of the forum’s organising committee to representatives from Peru, who will be hosting the V Latin American and Caribbean Forum in 2009. The Peruvian delegation was headed by Dr. José Luis Mesones, Peru’s National Aids Coordinator.

China is a country of expanding wealth, deep-rooted tradition, and honour, and is home to some of the world’s most famous landmarks. It is also a country which over the past few years has become increasingly affected by the AIDS epidemic.

In 2005 UNAIDS estimated that there were close to 650,000 people living with HIV in China, a country which has many factors that could lead to a rapid spread of the epidemic; high mobility, large-scale labour migration, high numbers of sex workers, low condom use, a large number of people who inject drugs, low overall awareness of AIDS as well as severe stigma and discrimination surrounding HIV.

“The Chinese government has increased the resources allocated to the response to AIDS in China significantly over the last four years,” said Joel Rehnstrom, UNAIDS’ Country Coordinator in China. “However, at the provincial level a lot still needs to be done. AIDS awareness is still much too low in the population and stigma and discrimination are serious problems that need to be dealt with,” he added.

The Beijing Ditan hospital, established in 1946,was
one of the first hospitals to support people living
with HIV in China and began providing antiretroviral
treatment in 1999.

The Beijing Ditan hospital, established in 1946, was one of the first hospitals to support people living with HIV in China and began providing antiretroviral treatment in 1999. This was also the year that the Red Ribbon Centre was established, to compliment the hospital’s work by providing care and support to people living with HIV.

“Ditan is a hospital specialized in infectious diseases and is one of China’s leading institutions on AIDS––so we have a duty to provide the best treatment and support we can,” said the General Secretary of the Red Ribbon Centre, Dr. Li Xingwang. “However there is still more we can do to improve HIV awareness in China and we call on medical professionals to join us in the response to AIDS. Starting with ourselves, we can work on eliminating the stigma around HIV in the medical community,” he added.

The Beijing Ditan hospital mainly receives patients from the Beijing municipality, however people from other provinces also come to the hospital to receive treatment. Many come because they have been refused entry into other hospitals or fear of disclosing their status in their local communities. The Red Ribbon Centre supports this policy and maintains an open door policy by welcoming anyone living with HIV seeking advice or support.

The Red Ribbon Centre is supported by the government and international organizations including UNAIDS. UNAIDS is also working with other partners in the country to engage positive networks and their members to help build capacity and raise awareness of the epidemic in China .

The Red Ribbon Centre is a place where people
living with HIV can communicate, network, and
above all, be themselves without fear of stigma or
discrimination.

The centre provides a number of services including information, HIV testing and care, as well as psychological support training for volunteers and a legal aid system to support people living with HIV. It is a place where people living with HIV can communicate, network, and above all, be themselves without fear of stigma or discrimination.

“The Red Ribbon Centre provides a friendly and harmonious environment for us. We can talk openly here. We get up to date information and professional support and care––this is our family,” said one of the centre’s members.

The Red Ribbon Centre also engages in educating the general population through a journal called ‘Hand in Hand’ developed in collaboration with people living with HIV. The journal places particular emphasis on raising awareness among young people.

“It is important that we educate young people in China, which is why we have provided training to more than 600 university students and hosted 13 health education activities in primary and middle schools,” said Dr. Li Xingwang.

China has made significant progress in scaling up its action on AIDS––increasing harm reduction programmes and providing treatment, care and support to people living with HIV. But there is still much to be done, particularly in the provinces. The Ditan hospital and the Red Ribbon Centre are important examples of what can be achieved and their treatment, support and education programmes are important initiatives in the country’s response to AIDS.