Sitting on center stage, clutching a microphone, Chinmay Modi along with a dozen young people answered questions about HIV during an all-youth panel session at the Amsterdam 2018 AIDS conference.

The 25-year-old born with HIV described his struggle accessing services. "In India, sex is a big taboo. A 16-year-old cannot buy condoms for example and parents need to give consent to be tested for HIV." He said educating children and parents is key. His greatest desire involves pushing for specific youth-focused services.

Dany Stolbunov from Ukraine echoed that sentiment, saying "Nothing for us, without us." He said that in his region stigma and discrimination kept people from even accessing services. He bemoaned the fact that young people in Ukraine have limited information and are not seen as a priority.  

HIV FACTS

In 2017, there were approximately 250 000 new HIV infections and 38 000 AIDS-related deaths among adolescents and 1.8 million adolescents living with HIV globally.

Adolescent girls in sub-Saharan Africa are disproportionately affected by new HIV infections, making up 56% of new HIV infections among adolescents globally.

HIV is a leading cause of death among adolescents (10-19 years).

"We are ready to fight for our rights," he added, explaining that young people have a voice and want to use it.

Bruna Martinez strongly believes that broad sexual education discussing gender, health issues and pleasure would not only limit stigma, it would also make teenagers fear HIV less.

"HIV should not be in a vacuum," she said. "We are a generation that can discuss sex and that's a great thing; so give us the tools that tip things in our favor."

All agreed that teenagers and young people have the most at stake in ending the HIV epidemic. Their demand is clear: go beyond scholarships by empowering us.

Melodi Tamarzians, the Dutch youth ambassador for sexual and reproductive health and rights, said, "Do not tick the youth box by giving us a token position." In her view, to enable young people, adults need to invest in them and give them advisory roles.

AIDS 2018 prided itself on giving a greater space to young people in Amsterdam. Youth and junior investigators made up more than one-third of the submissions presented at the conference, according to the conference organizer, the International AIDS Society (IAS.) In addition, young people got the most scholarships than at any other conference. And the Global Village (a free admission space by the conference area) featured the largest space conceived of and run by young people. It included a snack area, a mini-indoor football field, a safe-space theater area and youth-led activities, and booths such as a radio recording area, a youth against AIDS t-shirt stand and even an exhibit about the vagina.

Ms Martinez volunteered and then worked with the Amsterdam Youth Force that mobilized and organized other young people to make the youth space their own. "At this conference, we showed everybody that we could deliver," she said.

She hopes that this meaningful youth presence will carry over. "It's important that we are not being catered to but rather that we are recognized," she said, her AIDS 2018 lanyard laden with pins and stickers. She sees her recent stint with the Youth Force as a way to change things. "There are still so many young people getting infected with HIV and dying. It means we are failing and the system is not working," Ms Martinez said. In her view, HIV policy has to also come from the ground upwards. She emphasized peer-to-peer education and valuing local knowledge. Standing in front of a huge 'Let's face HIV together' she said, "We speak the language of the young people and we know what we are living, so acknowledge us fully."

Worldwide every year, 12 million girls under the age of 18 years are married—that's equivalent to 23 girls every minute. Married too soon. Their personal growth, health and fundamental rights and freedoms denied. Gender inequalities and gender-based violence force thousands of girls into marriage and motherhood. Girls with no education are three times as likely to marry by the age of 18 years as those with a secondary or higher education. And girls who marry before they are 15 years old are 50% more likely to face physical or sexual violence from a partner.

Child marriage often means that girls find it difficult to negotiate safer sex with their husbands, who are commonly older and more sexually experienced, making the girls especially vulnerable to HIV and other sexually transmitted infections.

UNAIDS’ latest report, Miles to go, highlights the reality that adolescent girls and young women aged 15–24 years, particularly those from sub-Saharan Africa, are being left behind. Every week, more than 6600 adolescent girls and young women become newly infected with HIV, with sub-Saharan African women and girls bearing the brunt, accounting for one in four HIV infections in 2017 despite being just 10% of the population.

Girls Not Brides, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Ministry of Foreign Affairs of the Netherlands and UNAIDS hosted a panel discussion on the issue of child marriage at the International AIDS Conference in Amsterdam, Netherlands, bringing together panellists from across regions, sectors and generations. Monica Geingos, the First Lady of Namibia, was a special guest speaker.

When girls and women are empowered with rights and given equitable access to education, enabled to participate fully in the labour force and equitably represented in government and decision-making bodies, the benefits far outreach improving the lives of the individual woman. Their families, communities and countries thrive. Yet, more than 150 million girls will become child brides by 2030.

The panellists highlighted the need to tackle the underlining determinants behind both HIV and child marriage. They emphasized the need for a comprehensive multisectoral and resourced approach. Gender inequality and harmful social norms have to be challenged. The solutions, they said, include keeping girls in school, providing health services that serve young people’s needs and mobilizing families and communities, including men and boys.

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Antiretroviral stock-outs are a serious public health problem in the Latin America region and represent an important risk to the sustainability of the HIV response, according to participants at AIDS2018.

On July 26, a session titled Sustainability of the response to HIV in Latin America; factors that impact access to drugs and health supplies addressed and analyzed the magnitude, the structural causes and the impact of stock-outs on the sustainability of the HIV response in Latin America. Participants discussed strategies to pave the way forward and highlighted best practices on joint purchases of antiretroviral (ARV) treatment like the PAHO/OMS strategic fund, which has helped prevent stock-outs.

In Latin America, one of the most important achievements in the HIV response has been the recognition that accessing HIV treatment is part of the right to health in the public health system, resulting in an increased number of people receiving antiretroviral treatment in recent years. However, a major challenge to fulfill the right to health is to guarantee uninterrupted supplies of ARV drugs and other essential health commodities.

According to the Pan American Health Organization (PAHO), in 2012 45% of the countries reported at least one stock-out episode; the figure had been 54% in 2010. Although some improvements are seen from 2010 to 2012, the region is still experiencing a high frequency of stock-outs.

Shortages of ARVs and other essential supplies result in changes and interruptions in patient treatment, threaten the lives of people with HIV and hamper the reduction of new HIV infections and AIDS-related deaths.

Participants at the session stressed the need for greater health system strengthening and joint procurement processes, including the incorporation of TRIPS flexibilities to reduce ARV costs, aligned with policies for simplified treatment regimens. According to participants, all these factors are essential to prevent and respond to stock-outs of ARVs and medical supplies.

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Maria Godlevskaya, a courageous community activist living with HIV from the Eastern Europe and Central Asia region, was the only Russian language speaker at the opening of the 22nd International AIDS Conference, AIDS2018. 

"We all deserve high-quality treatment, regardless of sexual orientation, beliefs and religious preferences. We all deserve a quality life with HIV and without it. For many people, stigma and discrimination remain the main barriers to access support to preserve their health and the health of their loved ones." said Maria Godlevskaya in her opening remarks at AIDS2018. "I believe in the community. As an indestructible link in the chain of resistance, I have defended, defend and will defend the rights of people living with HIV to have full quality of life and a high standard of living. I encourage everyone to support our campaign "Chase the virus, not people!" #chasethevirusnotpeople

Maria has been living with HIV for over 18 years. She openly speaks about her HIV status on television and openly shares her personal story with journalists. Maria leads a team of peer counselors and runs a video blog at E.V.A. - the first Russian network to support women affected by HIV. She shares her personal experience and disseminates the latest HIV news and information with people affected by the epidemic across Russia every day.

"Some people call me and others reach out to me via social media. I try to respond to every request. I think my life has changed dramatically and now I have found my purpose in life. It is priceless to be able to communicate with people around the world.”

Maria was diagnosed with HIV when she was 16 years old. "When you are 16, there is no panic. You are not frightened by horror stories about AIDS and not bound by social rules, so it was not hard for me to accept my HIV diagnosis. I was more worried about my mother. My diagnosis was like litmus paper - people who were afraid of HIV abandoned me, but the most trusted ones have remained forever.”

Maria has been working for different HIV organizations for many years, starting with providing counselling for people who were using drugs and living with HIV. "At that time there were no well developed communities to support people who use drugs. We helped those in remission to start treatment and stay adherent to treatment."

A few years ago, Maria became pregnant and gave a birth to a healthy baby. "When I met the father of my child, I immediately told him about my "peculiarity” and left him to choose to stay with me. And he gave me a beautiful answer: ‘Every person has something special’ he said.  So we stayed together, and he remained HIV negative.”

I stayed on HIV treatment throughout and after my pregnancy, and I was lucky to have a great relationship with my doctor. My pregnancy and birth is now an example for other women living with HIV. Today I get lots of questions from young Russian women about pregnancy, health care, obstetrical care for women with HIV, so I can share with them my positive experience.”

Maria’s organization, E.V.A. implements many projects in Saint Petersburg and across Russia, focused on providing HIV services for women and their families: support groups for women living with HIV and their families; trainings to increase medical literacy among people living with HIV, and help for women to communicate and negotiate with their doctors and care givers.

"Our trainings help women to adhere to treatment, minimize side effects, and manage undesirable consequences. We empower women to enhance their physical condition as they get used to taking ART long-term. We also support peer consellors so they can provide other women with moral and psychological support.”

Maria considers the main challenge of the growing HIV epidemic among women in Russia is that women have received little sexual education, lack a culture of safe and equal sexual relations and experience irregular monitoring of their HIV status. Many women simply do not identify themselves with any key population, and consider that having one regular sexual partner will safeguard their health. 

"Now we are seeing so many new HIV infections among women over the age of 50 - which brings new challenges as how to support these women. When a woman in her thirties learns her HIV positive status, she may understand how she acquired it. But women in their fifties or sixties are often shocked to learn they have HIV and they often think that their lives are over. In such cases, peer counsellors are so important because they can answer practical questions from their own personal experience.”

“I have a clear set of goals: I know why I'm doing what I do, and I have the energy and strength. I try to set real goals and don’t try to save the whole world – I’m just supporting those who really need help.”

As the dark monsoon clouds give way for the sun, yellowish crimson rays fall on Ambika’s face. She squints and continues to intently inspect the lush green lettuce she is growing in her backyard. The 17-year-old is living with HIV and lost both her parents to AIDS. With a glint in her eyes and a perpetual smile, she casually mentions that she likes to run in the mornings. Later, her coach proudly reveals that she is a 10-kilometre runner and is preparing to participate in the next Durban Marathon. Her friends Ashwini and Bhawani, aged 18 and 16 years, both living with HIV and 10 km runners themselves, proudly mention that, “Ambika won the Bangalore Ultra run. It was 12.5 km!”

These young women are a part of an initiative called Champion in Me that uses sport to respond to stigma and discrimination against adolescents living with HIV. Based in Bangalore, the programme uses running as a medium to empower them and strengthen their belief in themselves. Today, almost 200 children living with HIV are part of the programme, and it continues to expand. They live as a family together in the premises of Snehagram, an organization located in Tamil Nadu. Aimed at meeting the needs of adolescents living with HIV, the programme provides long- and short-term opportunities for academic learning and vocational skill development.

Manik and Babu, both 18 years old, are part of Champion in Me. They have participated in more than 20 runs, including at events such as the International Children’s Games in the Netherlands, the IDBI Marathon in New Delhi and the Boston Marathon. Their journey, challenges and experiences have been documented in Running Positive, a film screened at the International AIDS Conference, being held in in Amsterdam, Netherlands, from 23 to 27 July.

Manik said, “This film will motivate you to question the conventional image of an HIV-positive individual in India and the treatment meted out to them.” Babu explains that the film sheds light on how sports can be used to mainstream a segment of society that is vulnerable and discriminated against. 

Their elated coach, Elvis Joseph, said, “I have champions who are running not just for themselves, but for all their friends who are living with HIV.”

“These young people living with HIV have inspired all of us. They have now documented their lives in this touching movie,” said Bilali Camara, UNAIDS Country Director for India.

Estimating how many people living with HIV are on treatment is vital to keeping track of the success or otherwise of the global AIDS response. HIV treatment not only keeps people alive, but, through reducing the viral load of a person, greatly reduces the chance that a person living with HIV will transmit the virus to someone else.

UNAIDS published its latest estimates of the number of people living with HIV accessing antiretroviral therapy in its new report, Miles to go. An estimated 21.7 million [19.1–22.6 million] people of the 36.9 million [31.1–43.9 million] people living with HIV at the end of 2017 were on HIV treatment.

A total of 143 countries submitted the data that UNAIDS used to compile the estimate, representing 91% of all people estimated to be on treatment worldwide. Those 143 countries supply actual counts of people on treatment, not estimates, although estimates are used for those few countries that do not supply counts. Countries report their numbers of people on treatment—both adults and children, disaggregated by sex—through the Global AIDS Monitoring tool every six months. Similar data are included in the Spectrum epidemiological estimation software.

UNAIDS provides technical assistance and training to public health officials and clinical officers—the people who compile the numbers in the countries—to ensure that their reports on treatment coverage are accurate. In addition, every year, in partnership with the United Nations Children’s Fund, the World Health Organization and other partners that support the delivery of HIV treatment services, UNAIDS reviews and validates the treatment numbers reported through both the Global AIDS Monitoring tool and Spectrum.

When UNAIDS’ estimates of treatment coverage in countries are compared with estimates of treatment coverage made in Population-Based HIV Impact Assessments (PHIA) and other surveys, similar levels of treatment coverage are seen (see the attached graph).

In 2017, UNAIDS carried out a triangulation of data as a way to confirm or deny the results of its annual data collection. That analysis sought to answer a simple question: are enough antiretroviral medicines produced and bought to treat the number of people reported to be on antiretroviral therapy?

At the end of 2016, 19.4 million people globally were on antiretroviral therapy, with an estimated 14.1 million people accessing treatment in generic-accessible low- and middle-income countries.

A study of the exports and domestic procurement of antiretroviral medicines in 2016 from India showed 11.4 million person-years of treatment. When the generic antiretroviral medicines produced in other countries were included, an estimate of 14.2 million–16.2 million person-years on treatment was made—sufficient to treat the 14.1 million people in generic-accessible low- and middle-income countries.

In 2018, UNAIDS partnered with the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria and selected technical partners and ministries of health in 28 countries, most of which are in sub-Saharan Africa, to conduct data quality reviews of reported treatment numbers and, where over- or undercounting is found, to correct current and historical reports of treatment numbers. Previous data quality reviews since 2016 have been used to adjust estimates, for example by taking into account people who transfer from one clinic to another, but are reported by both clinics, or people who have died, left care or emigrated but are not identified and removed from treatment registries.

More details on the methods for calculating the number of people on treatment can be found in the annex on the methods in Miles to go, while details of how the triangulation was undertaken can be found in a publication published on an earlier triangulation exercise.

European Union political leaders met to discuss the successes, challenges and future priorities for addressing HIV in Europe at ministerial meeting in the margins of the 2018 AIDS conference.

The session started with a powerful appeal from the European civil society co-chair Esther Dixon-Williams (European AIDS Treatment Group) to ensure people living with HIV and key populations remain central to the discussions in keeping with the call from the inception of the AIDS response “nothing about us without us”.

A few European Union (EU) countries are on track to reach the 90-90-90 goals, however to reach the target of ending AIDS by 2030 and leaving no one behind, increased efforts to reach out to men who have sex with men, transgender people, migrants, sex workers, people who inject drugs and people in detention are needed.  

The rising epidemic among men who have sex with men in central and south eastern Europe was highlighted as well as the continuing emergency for people who use drugs in the eastern European states. HIV-related stigma and the criminalisation of people who use drugs, sex workers, MSM, transgender people are major obstacles to seeking, accessing or staying on treatment. Understanding this stigma and reducing it should be a key priority in the months and years ahead for the European Union institutions and its EU member states. Civil Society drew attention to the Ljubljana Declaration 2.0, a call for urgent action in response to rapidly expanding HIV epidemics among gay men, other men who have sex with men and trans people in newer EU member states and enlargement countries

Important announcements were made by Germany, France and the Netherlands highlighting that increasing demand and making pre-exposure prophylaxis (PREP) available and reimbursed nationally for all is a priority within the next months. It was highlighted that Europe needs to do more to ensure the right to health of migrants is respected.  Migrants must be protected from increased vulnerability to HIV to access needed health services regardless of residency or insurance status and that they are not returned to countries where there is no real access to treatment.

The ministerial meeting provided an opportunity to showcase the tremendous contribution European Union member states countries and the European Commission have made to the AIDS response globally and within their own borders. Participants highlighted that together the individual EU Member States and the EU itself via the European Commission contribute significantly to international funding for the AIDS response. The next Global Fund replenishment will be hosted in Paris, France in 2019. The role of the European Union is even more critical as international funding flatlines and the need is great for support particularly for countries in Eastern Europe and Central Asia.

The session was also an opportunity to hear about the innovations and excellent practices in some countries in the region. Speakers highlighting the importance of supportive legal environments and engagement of affected communities. Portugal highlighted its commitment to the agenda and the difference that introducing harm reduction approach has made as it has seen a drastic reduction in new HIV infections. The European Commission showed how an integrated approach to HIV, TB, viral hepatitis and STIs, as well as legal frameworks allowing for community engagement in health service delivery outside of medical settings is the way to reach more people and maximise investments at countries level.  This approach underpins the achievement of the Sustainable Development Goals on health and on justice. The city of Amsterdam showed it has virtually reached 90-90-90 with a city policy that supports the right to health, coordination between stakeholders and an inclusive and innovative environment for all citizens in the city. Speakers also highlighted the expanding epidemic in Eastern Europe and the need for increased collaboration with the region.

A focus on integrated health services, rights, reaching those at risk of being left behind and inclusiveness is emerging in a number of EU member states. Yet there is only twelve years to 2030 and efforts need to be sustained and expanded to ensure that Europe is on the Fast Track to ending AIDS – leaving no one behind

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A meeting at the 2018 International AIDS Conference, being held from 23 to 27 July in Amsterdam, Netherlands, has showcased how Kenya is responding to the challenges and opportunities on the way towards validation of the elimination of mother-to-child transmission of HIV in a high-burden context. 

Building on the Start Free Stay Free AIDS Free framework, specific attention is being given in Kenya to ensuring access to treatment for children and adolescents living with HIV, while addressing inequities, particularly among adolescent girls and young women.

The participants heard about the role of high-level champions—including community leaders, parents, religious leaders and other relevant stakeholders—highlighting the need for action at all levels, based on robust programmatic data.

Kenya has made significant progress in preventing new HIV infections among children, which fell from an estimated 13 000 in 2010 to 8000 in 2017. This has been possible through programmes such as the mentor mother initiative, which supports and cares for women living with HIV, the mother–baby pair approach, which synchronizes appointments for the mother and the child at the health facility, and audits of every child exposed to HIV in order to identify barriers in accessing health facilities.

The leadership of Margaret Kenyatta, the First Lady of Kenya, and her Beyond Zero Campaign have been instrumental in raising awareness on the importance of services to promote the health of mothers and children, including HIV prevention.

The participants heard, however, that more needs to be done to ensure that progress is equal across the country. Progress has been threatened by recent challenges, such as a health workers strike, which has affected antenatal care and testing coverage, and reduced community support, which has affected demand creation for HIV services.

The participants decided that there was an urgent need to scale up HIV programmes. This would be complemented by innovations in tracking the targets for paediatric and adolescent HIV and accounting for every mother and child. Furthermore, the resilience of the health system needs to be strengthened.

The meeting, held on 24 July, was jointly organized by the Ministry of Health of Kenya, UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation.

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Undetectable = untransmittable is the message of a new UNAIDS Explainer. With 20 years of evidence demonstrating that HIV treatment is highly effective in reducing the transmission of HIV, the evidence is now clear that people living with HIV with an undetectable viral load cannot transmit HIV sexually.

Three large studies of sexual HIV transmission among thousands of couples, one partner of which was living with HIV and the other was not, were undertaken between 2007 and 2016. In those studies, there was not a single case of sexual transmission of HIV from a virally suppressed person living with HIV to their HIV-negative partner. The Explainer cautions, however, that a person can only know whether he or she is virally suppressed by taking a viral load test.

For many people living with HIV, the news that they can no longer transmit HIV sexually is life-changing. In addition to being able to choose to have sex without a condom, many people living with HIV who are virally suppressed feel liberated from the stigma associated with living with the virus. The awareness that they can no longer transmit HIV sexually can provide people living with HIV with a strong sense of being agents of prevention in their approach to new or existing relationships.

The new UNAIDS Explainer series aims to inform readers about key or emerging issues in the AIDS response. With recommendations for programme managers and advice for national responses, they are short but informative snapshots of the current knowledge about an area of the AIDS response.

The youth bulge is not new. Younger generations have almost always been larger than the previous generation. However, before the twentieth century, high child mortality meant that a large proportion of children did not survive to adulthood.

Huge improvements in nutrition and health services over the past 30 years have had a significant impact on population trends in sub-Saharan Africa. Thanks to remarkable decreases in child mortality—and large decreases in mother-to-child transmission of HIV—child survival rates have improved significantly.

A new UNAIDS Explainer shows the effects that the youth bulge has had on the AIDS response. As the overall number of young people has grown, and coverage of prevention services remained the same, more young people have been put at risk of HIV infection.

An analysis of UNAIDS data shows that new HIV infections among young people aged 15–24 years declined by 22% between 2010 and 2017. However, had the population size and incidence rate remained stable, the decline in new HIV infections among young people aged 15–24 years would have been 36%.

The Explainer shows the challenges of the youth bulge, explains how young people are at higher risk of HIV and calls for countries to scale up their services for young people.

The new UNAIDS Explainer series aims to inform readers about key or emerging issues in the AIDS response. With recommendations for programme managers and advice for national responses, they are short but informative snapshots of the current knowledge about an area of the AIDS response.