The Russian Minister of Health, Veronika Skvortsova, has reiterated the commitment to reach the targets agreed at the 2016 United Nations General Assembly High-Level Meeting on Ending AIDS.

“We have to provide every person living with HIV with quick access to the correct treatment. The Ministry of Health plans to increase the coverage of people living with HIV who know their status on antiretroviral therapy to 75% by 2019, and by 2020 the figure should reach 90%,” said Ms Skvortsova at the 28th meeting of the Health Council of the Commonwealth of Independent States, held in Saransk, Russian Federation, on 4 September 2018.

In 2018, the Russian Federation reported for the first time on national progress towards the 90–90–90 targets—in 2017, 81% of people living with HIV in the Russian Federation knew their status, 45% who knew their status were on treatment and 75% who were on treatment were virally suppressed.

In order to improve strategic information and build evidence for decision-making at the local level, the Russian Ministry of Health recently conducted a workshop on HIV estimates for representatives of 10 Russian regions. Regional experts were trained on modelling HIV estimates, which will help to ensure a more complete picture of the number of people living with HIV and of the 90–90–90 targets at the subnational level.

Eastern Europe and central Asia is the only region in which the numbers of new HIV infections and AIDS-related death are still on the rise. At the end of 2017, the number of new HIV infections in the region reached 130 000. At the end of 2017, it was estimated that the 90–90–90 cascade in the region was 73%, 50% and 72%.

“The Russian Minister of Health’s statement is another important step in a series of consistent actions undertaken by the Government of the Russian Federation to accelerate the country’s Fast-Track approach to reach 90–90–90 by 2020,” said Vinay P. Saldanha, Director of the Regional Support Team for Eastern Europe and Central Asia.

First ladies from across Africa and the First Lady of China, Peng Liyuan, have reaffirmed their commitment to a future free from AIDS by spearheading a new joint initiative to prevent HIV among young people. China will work with African countries and international organizations to implement a three-year health promotion and HIV prevention advocacy programme for adolescents, starting in 2019.

The China–Africa advocacy campaign was launched on 4 September on the margins of the 2018 Beijing Summit of the Forum on China–Africa Cooperation (FOCAC), in Beijing, China. The campaign aims to increase young people’s access to integrated sexual and reproductive health and HIV services and strengthen their engagement in the AIDS response.

Globally, there are around 3.9 million young people between the ages of 15 and 24 years living with HIV. Around 1600 young people acquire HIV every day and a young person dies every 10 minutes from of an AIDS-related illness.

Michel Sidibé, the Executive Director of UNAIDS, thanked the first ladies for their collective action in the AIDS response and urged them to continue their high-level advocacy to mobilize resources to support youth engagement for HIV prevention, treatment and care. “Engaging young people means supporting them as partners and leaders in the AIDS response,” said Mr Sidibé. “We will only pick up the pace if we work closely with young people.”

Discussions during the event focused on addressing what puts young people at risk of HIV, including stigma, discrimination, gender-based violence and limited access to reproductive health services and information. The first ladies recognized that ending the AIDS epidemic among adolescents and young people requires amplifying investments where they can make the most difference, such as comprehensive sexuality education, and fostering innovative and multisectoral HIV prevention programmes.

During the event, Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization, spoke about HIV/tuberculosis coinfection. Tuberculosis is a leading cause of death of people living with HIV. 

The first ladies of Africa and China will join forces to stop new HIV infections among young people by sharing information, helping each other to build expertise and mobilizing resources for joint advocacy for HIV prevention.

The first ladies’ HIV advocacy event concluded with the endorsement of a joint statement that calls on governments to ensure HIV prevention, treatment, care and support services and universal health coverage, especially for young people, in order to ultimately reach the goal of ending the AIDS epidemic by 2030.

On the sidelines of FOCAC, Mr Sidibé and the First Lady of Malawi, Gertrude Mutharika, met with StarTimes to explore how best to harness new technologies to reach young people with HIV prevention services. StarTimes is using its platform to share HIV prevention and awareness messages through digital television and its new social media application.

An infectious disease can spread around the world in days. Human factors that have quickened the pace of virus transmission include the growing global population, urbanization and the industrialization of food production. The Smithsonian’s National Museum of Natural History in the United States of America features nine diseases that have spilled over from animals to humans in its newly opened exhibition, Outbreak: Epidemics in a Connected World.

One hundred years after the influenza pandemic, the three-year-long exhibition sheds a light on the causes of disease outbreaks such as Nipah virus and severe acute respiratory syndrome (SARS) and the various responses to epidemics.

“The 2014 Ebola outbreak in western Africa was the catalyst, but we wanted to have HIV—the pandemic of our time—as a big focus of the exhibition,” said Sabrina Sholts, the lead curator. For HIV, the museum created a three-dimensional timeline showing the landmarks of the AIDS response in the United States, from the activism to the science to the policy changes and treatment. Objects such as red ribbon pins, ACT UP T-shirts with a pink triangle with the saying Silence=Death, condoms, antiretroviral medicine bottles and photos guide visitors from the start of the HIV epidemic until now. A large touch table allows for people to explore new infections around the world today based on the latest UNAIDS data.

“We didn’t want to leave the impression that AIDS is over and limited to one place, so the interactive component resonates with people as to where we stand right now,” said Ms Sholts.

The UNAIDS Strategic Information Department worked with Ms Sholts’ team and provided specific epidemiological data. Timely and accurate data on diseases are the clues to trends in an epidemic. Displaying and using those data are critical pieces of our work,” senior UNAIDS epidemiologist Mary Mahy said.

Ms Sholts admits that making the data visually engaging was a challenge, but by simplifying the language and adding context, the digital interactive centerpiece works well.

The curator’s aim was to have visitors understand the varying difficulties of getting people to know their HIV status and ultimately the long-term benefits that that entails.

“Diseases are scary stuff, so for every dire challenge or obstacle, we created an “on the upside” component to highlight a success story or uplifting angle,” she said. For the HIV pandemic, the upsides focus on various organizations serving people in need, like the Ponce de Leon Center in Georgia, United States.

She explained that the main goal of Outbreak is to raise public awareness about pandemic risks with the perspective that human, animal and environmental health are all connected as one.

The exhibition also showcases a mock-up of an Ebola treatment ward and a game, played on touch screens, that has visitors simulate a variety of roles—epidemiologist, wildlife biologist or community worker—to complete tasks as a team to end an outbreak.

Part of Outbreak focuses on the detective work involved in tracking down and containing diseases. Future viruses are inevitable, which is why understanding human influence on their emergence and development is key. 

Touching wild animals, a lack of vaccination, unprotected sex and travelling when sick all contribute to a virus’ proliferation, linking distant and diverse populations to each other beyond their communities, countries and continents. The response to these diseases, therefore, must also involve everyone.

“We are all connected, we all matter and we have to think holistically, collaboratively and collectively,” Ms Sholts said.

For those not travelling to Washington, DC, the Smithsonian has a free pared-down version of the exhibition—including the UNAIDS interactive display—available for translation and customization worldwide.

The National Coordinator of Botswana’s National AIDS Coordinating Agency, Richard Matlhare, has warned that complacency risks derailing the country’s AIDS response.

“The government is committed to ending the AIDS epidemic,” he said at the Botswana International HIV Conference, which took place in Gaborone, Botswana, from 23 to 25 August. “The new National HIV and Strategic Framework 2018–2023, to be launched later, has positioned HIV prevention as a game-changer to achieve epidemic transition.”

In the 16 years since HIV treatment was first made available in its public health sector—one of the first countries in Africa to do so—Botswana has made significant progress on HIV treatment, with 84% of people living with HIV accessing treatment in 2017. However, fewer gains have been made in the area of HIV prevention, with the number of new HIV infections increasing from 13 000 in 2010 and to 14 000 in 2017.

In the face of these figures, Botswana is making efforts to revitalize its HIV prevention response. It has recently joined the Global HIV Prevention Coalition and the President, Mokgweetsi Masisi, has expressed his commitment to ending AIDS in Botswana. “How Botswana succeeds as a country will impact on the success of the Global HIV Prevention Coalition as a whole,” said Sheila Tlou, Co-Chair of the Global HIV Prevention Coalition, during the opening of the conference.

Efforts to revitalize HIV prevention in the eastern and southern African region include galvanizing high-level political leaders, policy-makers, community leaders, researchers, academic institutions, civil society and development partners for increased accountability and investment in HIV prevention. It requires countries to Fast-Track implementation and service delivery along the five pillars of HIV prevention, focusing on young women and adolescent girls, key populations, condoms, voluntary medical male circumcision and pre-exposure prophylaxis.

“The global AIDS response is at a precarious point. We’ve achieved partial success in saving lives, but these successes are giving way to complacency in HIV prevention,” said Jyothi Raja Nilambur Kovilakam, the UNAIDS Country Director in Botswana.

Health situation rooms—software platforms designed to support decision-making on countries’ health responses—are opening up across Africa, bridging data and decision-making in order to improve the health and lives of tens of millions of the world’s most vulnerable people.

Data integration, data warehousing and data visualization are the core of the situation room concept, providing transparent and improved information on a range of diseases. While situation rooms are virtual working space, some countries also use physical rooms in which the analytics can be discussed and acted upon.

The idea of a health situation room is that data—whether on the availability of HIV medicines, the effects of a strike by health-care workers or diagnoses of cervical cancer—are centralized, yet accessible to everyone. Whereas in the past health data on different diseases would be spread around several databases in assorted government ministries, disease-specific organizations, etc., situation rooms collect the data in one place, on one system, in a form that is easily shared. The information held by the situation room can be utilized on tablets or computers throughout the country.

“We must continue to innovate in our response to HIV,” said Michel Sidibé, the UNAIDS Executive Director. “Having reliable and up-to-date information is vital if the world is to meet its commitment to end AIDS and reach the Sustainable Development Goals.”

By pooling the health data in the virtual situation room, better and more focused health services can be made available to the people who need them. For example, having data on specific parts of a city helps to drive a location–population approach to HIV prevention services, ensuring that the right people are reached in the right place with the right services.

Through combining data on, for example, HIV, tuberculosis and cervical cancer, interlinkages between the diseases can be seen and responded to. Data can be viewed in real time, so, for example, levels of HIV medicines can be monitored in order to anticipate and respond to medicine stock-outs. Studying the effects of HIV test and treat campaigns in Uganda, the effectiveness of cervical cancer screening in Côte d’Ivoire and malaria testing and new diagnoses in Zambia are other examples how health situation rooms are benefiting health responses.

Five countries—Côte d’Ivoire, Kenya, Lesotho, Zambia and Uganda—have launched situation rooms. Data on indicators, including on HIV, tuberculosis, malaria, noncommunicable diseases and reproductive, maternal, newborn and child health are gathered, with different countries collecting different information depending on the local situation. Namibia, Mozambique and Zimbabwe are preparing to launch situation rooms, and several other countries are in the planning stage.

As part of its work, UNAIDS has been helping countries to set up their situation rooms, with UNAIDS working with countries to select the specific indicators and connecting data in the country to their situation room. Countries with existing data collection systems, that collect data separated by age and sex and at the local level, that have good Internet connectivity and that have qualified local staff are best placed to establish their own situation rooms.

The situation room programme has resulted in UNAIDS’ support to countries being enhanced, with UNAIDS able to support health information systems in a way unique in the United Nations system. UNAIDS is therefore supporting country and programmatic monitoring in a more meaningful way in those countries that have invested in situation rooms.

“For us, its strength is in bringing multiple data sets together, and sharing powerful analytics in a visual and understandable way,” said Andrew Kashoka, Deputy Director of Information Technology, Zambia Ministry of Health.

For the future, UNAIDS plans to ensure that countries have technical support so that they can continue to operate their situation rooms without support from UNAIDS. UNAIDS will also work with partners, including the Africa Centres for Disease Control and Prevention, the private sector and others, to reduce the dependency of countries on UNAIDS’ support in setting up and running the platforms.

Such investments in technology and collaboration between UNAIDS, governments and partners are driving innovative approaches to responding to AIDS and to ultimately ending the AIDS epidemic as a public health threat by 2030.

African ministers of health, the Chinese Minister of Health and others have examined ways in which China can be instrumental in building capacity for the local production of health commodities in Africa and in strengthening regulatory capacities. The participants met at the 2018 High-Level Meeting on China–Africa Health Cooperation, held on 16 and 17 August in Beijing, China.

Africa is hugely dependent on imported medicines and other health technologies. It is estimated that 70% of the pharmaceutical and medical products market is served by imports. Demand for health commodities is growing rapidly and cannot be met with Africa’s existing manufacturing capacity and sources of supply.

During the event, the Chinese participants learned about African best practices, including the progress made in expanding HIV treatment, responding to the HIV epidemic in rural areas and reducing new HIV infections among children.

“We are creating the enabling environments for investments in Nigeria and closing the gap in supply shortages for essential commodities. Now is the time to stimulate access and increase local production of essential medicines and health technologies in line with our goal of achieving universal health coverage,” said Isaac Adewole, the Nigerian Minister of Health.

The participants signed a six-point document, the China–Africa health cooperation 2018 Beijing initiative, which focuses on building a strong public health surveillance and response system in Africa and supporting the response to public health emergencies. The plan also includes a special focus on strengthening cooperation on HIV prevention, in particularly among young people and key populations.

The League of Cities of the Philippines (LCP) pledged to fast-track the AIDS response in the cities, by signing a partnership agreement with UNAIDS to reduce the number of new HIV infections in the country. The signing event took place on the fringe of the LCP’s 30th anniversary celebrations on 27 July 2018. More than 145 mayors and local representatives from cities attended the event, which included a gala dinner.

UNAIDS’ newly released report, Miles to go: closing gaps, breaking barriers, righting injustices, shows that the annual new infections have more than doubled in the Philippines in the past seven years to an estimated 12,000 in 2017. With a 174% increase since 2010, the Philippines is the country with the fastest growing HIV epidemic in the Asia and the Pacific region. New infections have now overtaken Thailand, Viet Nam and Myanmar, placing Philippines number 5 in terms of new infections in 2018 in the region. Cities and urban areas are particularly affected. Health authorities say that 70 cities, including the 17 cities in metro Manila, accounted for 80% of reported HIV cases in the country.

“The AIDS epidemic in the country is an issue that needs urgent action among local governments, especially since key populations at risk of infections reside mostly in the cities,” said Laarni L. Cayetano, National Chair of the League of Cities of the Philippines.

Most agreed that there is a need to scale-up services tailored to key populations that go beyond female sex workers.   More than 90% of new HIV infections are occurring among men who have sex with men (MSM) and transgender people (TG). Condom use among men who have sex with men and transgender people hovers at 50% and 37% respectively and HIV testing is low. Only 16% of MSM knew their HIV status in 2015.

Local governments in the Philippines have earmarked resources and started more innovative HIV prevention services. For example, Quezon City has opened three Sundown clinics (Klinikas) that provide rapid HIV testing and counseling in a non-stigmatizing environment for gay men, men who have sex with men and transgender people. The city has also increased its HIV funding nine times since 2012 and has been urging other provinces to follow suit.

“Philippines has a small window of opportunity to act fast and stop a major HIV epidemic from taking hold,” said Eamonn Murphy, UNAIDS Regional Director for the Asia and the Pacific. He added, “This commitment is achievable if cities where the epidemic is having a big impact take the lead.” He also reaffirmed UNAIDS commitment to work in close partnerships with national and local authorities to support their efforts to bring HIV infections under control and provide technical expertise in how best to invest funds and reach people.

For the National President of the League of Cities of the Philippines, Edgardo D. Pamintuan, time is of the essence.  “I strongly believe that if we effectively implement HIV response strategies in our localities though our partnership with UNAIDS, our efforts at the city level can make a significant impact in reaching the country’s targets,” he said.

A global coalition of more than 80 youth organizations working on HIV (the PACT), and Youth Voices Count (YVC) launched a poll to get a sense of what young people know about sexual reproductive health.

More than half of the 270,000 young people aged 10-24 from 21 countries who responded to the U-Report poll (54% of boys and young men, and 58% of girls and young women) sought HIV and other services at a health centre or clinic in the previous three months.  About 36% of young people aged 10-24 who did not seek services reported feeling uncomfortable visiting a health centre or clinic, and more than 28% of young people (both sexes) said they felt scared to seek services.

The poll with support from UNAIDS, UNICEF and UNFPA was complemented by an in-depth survey and interviews led by YVC, which showed that approximately 15% of those who accessed any sexual health services in the past 6 months experienced refusal or mistreatment because of their age, sexual orientation, gender identity or HIV status. And of those who felt mistreated because of their age, 55% identified as gay, bisexual, and 25% identified themselves as living with HIV. Further, 32% of young gay, bisexual men and other young men who have sex with men, and 50% of young transgender people, felt that they had been discriminated against because of their gender identity or sexual orientation. Finally,16% of young people who identified themselves as living with HIV said they had been mistreated because of their HIV status.

Although healthcare settings should be safe spaces for those receiving care, this is not the case. Policies and attitudes remain barriers to youth-friendly HIV and sexual and reproductive health services. Indeed, 37% of respondents who reported having visited a clinic were not willing to recommend doing so to their peers.

This year’s theme for International Youth Day is Safe Spaces for Youth, highlighting the need of young people for safe spaces to come together, hang out, and participate in decision making processes as well as freely express themselves. This includes in healthcare settings, which should be places of safety and refuge, free from stigma, maltreatment, and violence.

Every day, approximately 1600 young people are infected with HIV, while one young person dies of AIDS-related illnesses every 10 minutes. Young women aged 15-24 are particularly affected. In sub-Saharan Africa, young women are twice as likely to be infected with HIV as their male counterparts. And young key populations (including gay men and other men who have sex with men, bisexual people, transgender people, young sex workers and young people who inject drugs) are at a high risk of HIV around the world due to rights violations, discrimination, exclusion, criminalization and violence. Of the young people living with HIV globally, most do not know their status.

Download more slides like this from 2018 Global AIDS Update Miles to Go 

Some 18 months after the launch of the catch-up plan, the National AIDS Council (CNLS), the Ministry of Health and UNAIDS co-organized a workshop in Bangui, to take stock of the progress and the challenges to accelerate access to treatment for people living with HIV in the Central African Republic. The workshop also served as an opportunity to renew political commitment to the HIV response and to call for urgent action on prevention.

The Prime Minister of the Central African Republic, Simplice Mathieu Sarandji, opened the meeting with 80 stakeholders present, including members of government, civil society organisations, people living with HIV, members of key populations, as well as local governments, traditional and religious leaders.

Key areas of progress since the launch of the catch-up plan in January 2017 included the development of new policies to implement test and treat, and the increase in the number of people on HIV treatment from 25,000 in 2016 to 34,000 in June 2018. Community treatment groups have been delivering HIV treatment to people in remote and insecure regions such as the eastern town of Zemio. In addition, a community treatment observatory is helping monitor access to and quality of HIV care in Bangui.

However, there are miles to go. Less than 35% of people living with HIV in Central African Republic access treatment — this is among the lowest in sub-Saharan Africa. Challenges include an inadequate monitoring and evaluation system, a lack of effective supervision of facilities providing HIV services, limited community engagement to implement HIV testing and treatment, as well as limited financial commitments to reach treatment targets. Most agreed on the need to improve coordination.

As a result, participants identified priorities for the next six months to reach treatment targets for 2019. All stressed that communities, people living with HIV and key populations must be involved every step of the way. In addition, participants stressed the urgent need for increased domestic and donor funding.

A steering committee and technical working groups prepared the two-day workshop based on available data and on-the ground site visits. The groups included representatives from the Ministry of Health, CNLS, community organisations, people living with HIV, international NGOs such as Medécins Sans Frontières and the French Red Cross as well as UNICEF, UNFPA, WHO and UNAIDS.

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Thailand is starting to roll out pre-exposure prophylaxis (PrEP) for HIV prevention among key higher-risk groups in high burden provinces, scaling up PrEP pilot projects within the national health system. The announcement was made at the satellite session “Breaking barriers and building bridges toward sustainability of the AIDS response in South-East Asia” during the International AIDS Conference in Amsterdam, Netherlands.

At the session, Dr Panumard Yarnwaidsakul, Deputy Director-General of the Department of Disease Control, Ministry of Public Health, said that the country is moving from trials and demonstration projects to policy and practice. PrEP now is a core part of the combination prevention package in the national HIV response in the country. Mr Yarnwaidsakul added that Thailand is also in process of including PrEP provision as part of the benefits package under the country’s universal health coverage.

As with many countries in Asia and the Pacific, Thailand's epidemic is focused among gay men and other men who have sex with men, transgender people and people who use drugs. The representatives of the Thai government acknowledged that PrEP is cost-effective and is an innovative approach for people at substantial risk of HIV infection.

Randomized trials have demonstrated that PrEP can decrease HIV incidence among at-risk populations, including men who have sex with men and sero-discordant couples. It has been shown that offering PrEP can encourage more people at higher risk to attend HIV clinics, undergo HIV testing and access either PrEP or treatment depending on the test result.

In Thailand, the discussion about offering PrEP at scale started in 2010.

The satellite session learned from "The Princess PrEP", a successful key population-led PrEP initiative under the support of Her Royal Highness Princess Soamsawali and PEPFAR/ USAID LINKAGES Thailand project.This effort served as local evidence to support the development of PrEP roll-out, where key population-led health services are a critical component.

As a next step, the Ministry of Public Health aims to train health care workers and key population peer providers to deliver PrEP.

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