Ministers of health and senior policy-makers from 10 countries in eastern Europe and central Asia reaffirmed their political commitment to scale up national HIV responses during a ministerial policy dialogue on HIV, which was held on the eve of the International AIDS Conference in Amsterdam, Netherlands.

The participants exchanged their experiences and the results of their national AIDS responses with a view to adapting them and scaling them up across the region. They discussed the Fast-Track priorities for achieving the 90–90–90 targets, whereby, by 2020, 90% of people living with HIV will know their HIV status, 90% of people who know their HIV-positive status will be accessing treatment and 90% of people on treatment will have suppressed viral loads. The Fast-Track priorities include the scale-up of domestic funding, the continued focus on key populations, strengthening collaboration across sectors and working in partnership with civil society and people living with HIV.

According to the recent UNAIDS report Miles to go, in eastern Europe and central Asia the annual number of new HIV infections has doubled since 2010—one of the only regions of the world in which HIV continues to increase.

Stigma and discrimination discourages HIV testing and treatment uptake. Harm reduction services remain essential in a region where nearly one third of new HIV infections are among people who inject drugs. Harm reduction programmes are in place across the region, but often at a limited scale.

At the end of 2017, among the 1.4 million people living with HIV in eastern Europe and central Asia, 73% were aware of their HIV status, an increase from 69% in 2016. A majority of the countries in the region have officially adopted test and treat, but owing to resource constraints and barriers to treatment among key populations, the pace of treatment scale-up is slow and coverage remains among the lowest in the world. About 520 000 people were accessing antiretroviral therapy in 2017, just 36% of all people living with HIV in the region.

During the dialogue, the Compendium of good practices in the health sector response to HIV in the WHO European region, featuring 52 successful examples from 32 countries, was launched.

The dialogue was organized by the World Health Organization Regional Office for Europe and UNAIDS, in cooperation with the Government of the Netherlands.

Quotes

Faith Building Bridges, the interfaith pre-conference event that was held before the International AIDS Conference, ended on 22 July. The participants joined together in a common voice to demand that the world recommit to ending AIDS and that world leaders take strong actions now, and in the future, to ensure that the AIDS epidemic is brought to an end.

Some 150 representatives of faith-based organizations, religious leaders, health-care providers, activists, policy-makers and other stakeholders attended Faith Building Bridges, which was convened by the World Council of Churches–Ecumenical Advocacy Alliance. Sessions included migration and how it puts people at risk of HIV infection, role of faith groups in ending TB, as well as how faith communities can strategically support children and adolescents living with HIV.

At the closure of Faith Building Bridges, faith activities transitioned to the faith networking zone in the Global Village, where UNAIDS Executive Director Michel Sidibé engaged faith leaders in a lively dialogue on 24 July. He focused on the critical role of faith communities as champions of social justice to help eliminate HIV-related stigma and discrimination.

Commemorating friends who died from AIDS-related illnesses and expressing hope and solidarity, people of diverse faiths came together in an interfaith prayer and memorial service on 23 July at the Keizersgrachtkerk in Amsterdam.

People of faith marched in solidarity with other conference delegates from the interfaith prayer service to the International AIDS Conference, expressing solidarity and commitment to the global response to HIV.

An interfaith networking zone in the Global Village will include events focusing on the importance of religious leadership in promoting HIV testing, testing and treatment for children and adolescents, addressing tuberculosis and HIV coinfection and strengthening interfaith responses to HIV.

Quotes

The PACT, a global coalition of youth organizations working on HIV and sexual and reproductive health and rights, gathered in Amsterdam, Netherlands, on 24 July at the International AIDS Conference, a year after launching #UPROOT, a youth-led political agenda to end AIDS by 2030.

The session saw youth advocates share materials developed by #UPROOT to inspire and mobilize more young people to act at the country level to challenge harmful laws, advocate for youth participation in the AIDS response and build strategic and more resilient partnerships to end AIDS.

Discussions focused on persisting legal barriers that young people face to access services, including age of consent laws on HIV testing and treatment. In 2017, 73% of 125 countries reported having age of consent requirements for HIV testing, out of which 31% require consent for adolescents younger than 18 years old. The PACT, through the #UPROOT agenda, has developed a set of policy briefs aimed at youth advocates to tackle these legal and policy constrains to access services.

Young people’s participation in the HIV response was highlighted as a key determinant to ensure its effectiveness and sustainability. Youth participation in key decision-making spaces is still a challenge. A recent UNAIDS report, Youth and HIV: mainstreaming a three-lens approach to youth participation, suggests that “while young people participate in the development, consultation, validation or review of strategic documents that guide the HIV response at the country level, they participate much less frequently in spaces where decisions are made about the policy framework or resources invested in the HIV response.”

Greater technical and financial support to young people’s participation in community responses to HIV was also highlighted as a pending need of youth-led organizations and networks working on HIV.

Strengthening collaboration between medical students and young key populations to reform national medical curricula in order to tackle discrimination in health care was also a focus of the session. In 2017, under the #UPROOT agenda, the International Federation of Medical Students Associations signed a memorandum of understanding with youth organizations and networks, including networks of young key populations and young people living with HIV, to respond to discrimination in health care, resulting in stronger collaborations in several countries, including Egypt and Uganda.

All the resources developed by the #UPROOT agenda thus far, including guidance on youth organizing, advocacy and accountability in advancing the AIDS response and young people’s rights, will soon be available on an online action centre.

Quotes

Analysis of social media use shows that, on the whole, most users tend to engage most with information that aligns to their existing beliefs and perceptions on the world. This phenomenon has been described as the echo chamber effect, whereby users find themselves surrounded, in general, by content from like-minded people and preferred information sources.

Echo chambers can be an opportunity as well as a barrier in the response to HIV. Some online communities offer spaces for people to access and share HIV-related information and resources in a stigma-free manner. On the other hand, echo chambers can also enhance stigmatization, promote discriminatory behaviours or spread inaccurate or false information. To some extent, the echo chamber effect can limit the ability of individuals or organizations to reach people outside of their natural audience bases.

UNAIDS and ViiV Healthcare chaired a symposium on breaking out of such echo chambers at the International AIDS Conference, being held from 23 to 27 July in Amsterdam, Netherlands. The panellists discussed various ways of being heard in a cluttered digital and non-digital space that has radically changed in the past decades.

Science magazine reporter Jon Cohen explained how he uses print, radio, television and Twitter to keep up with the onslaught of news. Despite the non-stop nature of his job, he stressed the importance of quality journalism.

“A medium is a medium and sadly a lot of people do not use the vehicle they have to tell stories well,” he said, likening it to a doctor not using his sharpest tool during an operation. In his opinion, it’s easy to lose readers and viewers, so he advised people to engage as much as possible with their audience and avoid preaching to people.

“Even if I offend people, I describe the reality, because I want you to see it and feel it,” he said.

Georgia Arnold, the Executive Director of the MTV Staying Alive Foundation, explained that the HIV television drama Shuga had had such a successful run for the past nine years because the show focused on teens and spoke to them at their level. It depicts relatable characters that deal with real issues and there is constant youth-based feedback. Recently, MTV introduced a gay character, which she said demanded some adjustment because some countries outlaw homosexuality.

“Use technology to transcend boundaries,” she said, explaining how MTV had to air two versions of the show but uploaded the gay version to YouTube and followed up on Twitter and Instagram. “Flex boundaries, do not smash them,” she advised.

J.P. Mokgethi-Heath couldn’t agree more. He is a policy adviser on HIV and theology for the Church of Sweden and uses his pulpit and sacred texts to reach his audience. “I help people understand texts in a different way,” he said. For him, his style of storytelling in person leads to an immediate response, so he aims to always stay true to his beliefs.

Immediacy and immersion drove Rowan Pybus and Sydelle Willow-Smith to try their hand at virtual reality video-making. The founders of Makhulu Productions based their 3-D short films on young South Africans’ experiences and highlighted one adolescent girl’s journey with HIV, making viewers feel like they are walking into a clinic for an HIV test.

“Virtual reality can have a physical effect on people, and that is a very exciting space to be in,” Mr Pybus said. Ms Willow-Smith added that the fact that Google, UNAIDS, the Desmond Tutu HIV Foundation and the Children’s Radio Foundation all partnered to make the films possible reflects how there is real interest to “break out of individual echo chambers.”

UNAIDS Communications Director Mahesh Mahalingam said that World AIDS Day provides a great opportunity to reach out to people about HIV. Last year, he said, UNAIDS wanted to communicate in a fresh way. The team produced a magazine-like report on the right to health in general, going beyond issues related to HIV. Various communities weighed-in in a series of questions and answers on what the right to health means to them.

“People got to say what they wanted through the UNAIDS mouthpiece, allowing us to break barriers and reach new audiences,” he said.

The symposium ended with ViiV Healthcare and UNAIDS announcing a new digital storytelling challenge prize. “If you feel you engage hard-to-reach groups on issues related to HIV prevention, testing, care and/or stigma, then apply,” said ViiV Healthcare Positive Action’s Jennifer Carpenter. She also recognized the two winners of the Every Footstep Counts video competition, Rogers Simiyu from the Elisabeth Glaser Pediatric AIDS Foundation and Joseph Baguma of THETA-Uganda.

There has been global progress in accelerating towards the 90–90–90 targets—whereby, by 2020, 90% of people living with HIV will know their HIV status, 90% of people who know their HIV-positive status will be accessing treatment and 90% of people on treatment will have suppressed viral loads—since their launch at the International AIDS Conference in 2014 in Melbourne, Australia.

Four years later, global leaders from civil society, governments, the private sector and academia came together for a two-day workshop, on 21 and 22 July in Amsterdam, Netherlands, to highlight the successes, identify gaps and share best practices in order to reach 90–90–90.

By the end of 2017, the world had achieved 75–79–81. Globally, 75% of people living with HIV know their status, 79% of people living with HIV who know their status are accessing antiretroviral therapy and 81% of people accessing treatment had suppressed viral loads.

The participants at the workshop reviewed the progress made with the rapid adoption of global policies, political commitment, the engagement of civil society and regular evaluation of progress and gaps.

Despite the global successes, evidence presented at the workshop showed that entire regions and populations are still being left behind. Progress in eastern Europe and central Asia, western and central Africa and the Middle East and North Africa is falling behind. Key populations, adolescents and men are not being reached by traditional health facility-based HIV testing services. Lack of political commitment, user fees and stigma and discrimination are some of the barriers to progress.

During the session, the participants discussed ways to identify and correct gaps and direct resources to where they are most needed, including by investing in data collection, reducing the turnaround time from testing to treatment initiation, prioritizing adherence and retention in care, increasing access to affordable viral load testing and the meaningful engagement of civil society in order to reach the people currently being left behind.

The participants also called for the political commitment and financial resources needed to make 90–90–90 a reality everywhere.

Quotes

On 23 July, the Global HIV Prevention Coalition brought together HIV prevention leaders in Amsterdam, Netherlands, to discuss the urgency of scaling up HIV prevention services. They shared the progress made and looked at the challenges, including policy barriers and inadequate funding for prevention.

The speakers highlighted the initial progress made since the launch of the Global HIV Prevention Coalition in October 2017. National prevention coalitions engaging many sectors and civil society organizations have been established to better coordinate responses. Ambitious prevention programme targets have been set in many countries and newly launched HIV strategies focus on prevention.

However, the limited capacities of national programmes and a steady decline in prevention funding have put the end of AIDS at risk. Policies on age of consent in about half of all coalition countries remain major barriers to adolescents’ access to HIV and sexual and reproductive health services. Many countries lack sufficient data on key populations and hence reach few of them. Stigma and discrimination further prevent key populations from accessing services.

The heads of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) underlined the need for adequate investments focused on the people with the highest HIV prevention needs.

Alvaro Bermejo, the Director-General of the International Planned Parenthood Federation, made a passionate appeal to donors and programmes not to forget condoms. All young people and members of key populations need easy access, he said, which was why the current gap in condom programming has to be closed.

For prevention efforts to be sustainable, civil society should be meaningfully engaged in national coalitions and their expertise and comparative advantage in implementation used and linked to adequate funding.  

Given these challenges and an ambitious prevention agenda to be implemented in only two and a half years, rapid action is required. The call made by the prevention leaders was a clear step in the right direction.

The participants of the event included the Minister of Health of South Africa, Aaron Motsoaledi, representatives of civil society and the heads of PEPFAR and the Global Fund. Michel Sidibé, the Executive Director of UNAIDS, and Natalia Kanem, the Executive Director of the United Nations Population Fund, convened the high-level panel.

Quotes

The 22nd International AIDS Conference opened on 23 July in Amsterdam, Netherlands. Under the theme “Breaking barriers, building bridges”, the conference will draw attention to the need of rights-based approaches to more effectively reach key populations. 

This year’s theme echoes one of the messages in UNAIDS’ latest report, Miles to go—that key populations are not being considered enough in HIV programming. Key populations and their sexual partners account for 47% of new HIV infections worldwide and 97% of new HIV infections in eastern Europe and central Asia, where one third of new HIV infections are among people who inject drugs.

The International AIDS Conference, which will run from 23 to 27 July, is the largest conference on any global health issue in the world and provides a unique forum for the intersection of science, advocacy and human rights. Bringing more than 15 000 participants together, the conference is an opportunity to strengthen policies and programmes that ensure an evidence-informed response to the epidemic.

The conference was officially opened by Princess Mabel van Oranje, the International AIDS Conference Chair, Linda-Gail Bekker, the UNAIDS Executive Director, Michel Sidibé, the Director-General of the World Health Organization, Tedros Adhanom Gebreheyesus, and artist and winner of the Eurovision Song Contest in 2014, Conchita Wurst.

Speaking at the opening ceremony, Mr Sidibé stressed that the pace of progress is not fast enough to meet the 2020 targets. He sounded the alarm on the growing inequalities and intolerance for diversity that are resulting in an HIV prevention crisis. He noted the need to break barriers that exclude people from their rights.

He also highlighted the need to close the gaps, specially the funding gap. “Like you, I worry about the funding gap. There is a persistent 20% gap between what is needed and what is available. We know small cuts can have big consequences. A fully funded AIDS response is non-negotiable,” said Mr Sidibé.

The conference is set to emphasize the need to promote human rights-based and evidence-informed HIV responses that are tailored to the needs of vulnerable communities, activate and galvanize political commitment and accountability among governments, donors, the private sector and civil society and address gaps in and highlight the critical role of HIV prevention.

During the coming days there will be opportunities for sharing knowledge, ideas and good practices through plenary discussions, abstract presentations, symposia, skills-building workshops, attendance at the Global Village community space and numerous independent events.

Stigma and discrimination in health-care settings is a major obstacle to ending AIDS. Widespread across the world, stigma and discrimination seriously reduces the quality of life of people who experience it and hinders their access to health and HIV services.

How to catalyse country initiatives and reduce stigma and discrimination in health-care facilities was the focus of a session at the International AIDS Conference on 23 July in Amsterdam, Netherlands. The session, Catalyzing Thailand and Regional Initiatives on Zero Discrimination in Healthcare Settings and Building Bridges Towards a Global Compact to Eliminate all Forms of HIV-Related Stigma and Discrimination, brought together representatives of the Governments of Thailand, Viet Nam and the Netherlands and representatives of regional civil society networks, the United States Centers for Disease Control and Prevention and UNAIDS.

Thailand is acknowledged as a pioneer in reducing stigma and discrimination in health-care settings in Asia through its innovative system-wide response. The event heard that the Thai stigma and discrimination reduction package is based on global measuring tools and contains a permanent monitoring system, evidence-informed actions at health facilities and community engagement at all levels.

Viet Nam piloted a stigma and discrimination reduction programme in Ho Chi Minh. At the session, Huu Thuy Do, Head of the Information, Education and Communication Department of the Viet Nam Administration for AIDS Control, explained how Viet Nam learned from cooperation with Thailand and how the Thai model was translated to the city level in Viet Nam.

Based on the experiences of Thailand and Viet Nam, speakers encouraged countries to foster cross-border links on stigma and discrimination reduction efforts in health-care settings in order to achieve more effective and efficient joint global action.

The participants also learned from the Dutch approach, which directs attention to the inequality of access to HIV prevention and treatment services while promoting an enabling legal environment to prevent stigma and discrimination.

The participants heard that the greater engagement of communities, people living with HIV and key populations in the development and monitoring of programmes against stigma and discrimination is a core element for successful stigma and discrimination reduction programmes. Their participation not only increases access by hard-to-reach communities, but also helps ensure that a rights-based approach is used.

The event concluded with the presentation of the Global Framework for Action, an initiative led by civil society that aims to catalyse and accelerate the implementation of commitments made to end HIV-related stigma and discrimination in different settings.

Quotes

Monaco has joined a network of more than 250 cities worldwide by signing the Paris Declaration, making a commitment to Fast-Track its response to the HIV epidemic and adopt the 90–90–90 targets.

The 90-90-90 targets are that, by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people living with HIV will have access to antiretroviral therapy and 90% of all people on antiretroviral therapy will have viral suppression.     

At a ceremony attended by Princess Stephanie of Monaco, who is also the President of Fight AIDS Monaco and a UNAIDS International Goodwill Ambassador, the Mayor of the Principality, Georges Marsan, stressed the importance of testing as the entry point to getting people on treatment and keeping them healthy.   

Twice a year since 2012, Monaco has taken its HIV testing campaign to the streets of the principality through its Test in the City campaign. In his speech, the mayor also underlined the importance of preventing new HIV infections.   

In his remarks at the event, UNAIDS Executive Director Michel Sidibé recalled visiting South Africa with Princess Stephanie in 2009, when just several hundred thousand people in the country had access to antiretroviral therapy to keep them alive and healthy. Today, he said, that number has expanded to 4.3 million people.

Mr Sidibé added that cities had a vital role to play as hubs of innovation and research and that they could help reach forgotten groups of people at risk of HIV infection.  

Also present at the event were Monaco’s Minister of Health and Social Affairs, Didier Gamerdinger, and the Vice-President of the International Association of Providers of AIDS Care, Bertrand Audoin.

The China children’s summer camp kicked off it’s annual activities this year in Liangshan, an autonomous prefecture in the south of the Chinese province of Sichuan. Sichuan is one of the largest provinces in China, it is also one of the most affected by HIV which is why this camp is so important. The camp brings together children who are living with HIV and runs under the theme “love in the sunshine”. At the camp the children are encouraged to participate in a wide range of activities in an environment they feel safe in, where they won’t be judged and where they will be respected by the other children and staff.

The event was one of a series of activities the Executive Director of UNAIDS Michel Sidibé was invited to participate in by the First Lady of China as part of UNAIDS and China’s strengthened cooperation and joint commitment for a robust response to HIV both in China and around the world.

One such activity was a visit to the Xichang University. Universities are playing a key role in the response to HIV. Xichang University for example, is encouraging students to actively engage in HIV prevention efforts in the community. During the visit the group, which included the Chinese Vice Minister of Health, joined in Red Ribbon Youth activities and spoke to students about their experiences as HIV prevention volunteers going out into villages to raise awareness of HIV prevention. 

Mr. Sidibé also met with Governor of Sichuan Province Yin Li in Chengdu, who governs over the 80 million strong population who live in the Province. He said that in recent years, HIV prevention and control efforts in Sichuan have made positive progress, a significant step forwards for a province which is home to more people than France or the United Kingdom. He also said that he would like Sichuan to further strengthen its cooperation with UNAIDS to explore more effective ways of stopping HIV and ensuring access to treatment. 

Before arriving in Liangshan, the Executive Director of UNAIDS attended serval important meetings in Beijing including a meeting with the Chinese Vice Premier Sun Chunlan who commended UNAIDS on the robust response to HIV. She said that China stood ready to work together with UNAIDS on HIV prevention and treatment efforts to improve the health and well-being of people around the world.

Mr Sidibé also met with the Chinese National Drug Administration and congratulated the Chinese government for its achievements in drug regulatory reform. China has extensive pharmaceutical production capacity and an important drug regulatory system. He stressed that there are great opportunities for China and Africa cooperation in trade, technology transfer and local production of medicines.

Also in Beijing, Mr. Sidibé joined the community of people living with HIV for a meaningful discussion on the implementation of 90-90-90 in China. He called for more efforts to make HIV testing and immediate treatment become a reality everywhere and to ensure the availability and accessibility of simplified, high quality drug regimens.

The Joint UN team in China is working hand in hand with the Chinese government, partners and communities to achieve "zero new HIV infections, zero discrimination, and zero AIDS-related deaths."  On 20 June 2018 the Joint UN team launched its Joint Work Plan on AIDS in China further strengthen efforts to end AIDS in China.