Margaret Kenyatta, the First Lady of Kenya, reinforced her commitment to champion the elimination of mother-to-child transmission of HIV in a meeting with UNAIDS Deputy Executive Director Gunilla Carlsson in Nairobi, Kenya, on 29 May.

The First Lady and Ms Carlsson discussed the Beyond Zero platform, a groundbreaking initiative spearheaded by the First Lady. Through Beyond Zero, the First Lady has mobilized resources from the private sector to respond to the health and well-being of women and children, with a focus on HIV and sexual and reproductive health.

“There is so much momentum and support from Kenyans themselves for the Beyond Zero initiative. They feel that it is theirs and that they own it,” said Ms Kenyatta.

Beyond Zero has delivered 52 mobile clinics to every county in Kenya. The operationalization of the clinics has resulted in substantial community mobilization and demand creation for HIV services. Initiatives such as Beyond Zero have contributed to significant progress in the AIDS response in Kenya, with new HIV infections among children aged 0 to 14 years reducing from about 14 000 in 2013 to 6100 in 2016, while in the same period the percentage of mothers delivering without a skilled health provider decreased from 56% to 34%.

Building on those gains, the First Lady launched a new framework earlier this year to advance the Beyond Zero initiative. The framework adopts a life-cycle approach, addressing challenges, including HIV, at different stages of life. Ms Kenyatta’s championship for Kenya to reach validation by the World Health Organization for the pre-elimination of mother-to-child transmission of HIV is a core commitment of the framework.

“Beyond Zero is a powerful initiative. An advocacy platform that has fostered public–private partnership for the health agenda and the elimination of mother-to-child transmission of HIV in particular,” said Ms Carlsson.

In response to a call by women living with HIV in Egypt for an increase in the availability of quality sexual and reproductive health services delivered free from stigma and discrimination, UNAIDS mobilized partners and engaged with Egypt’s national AIDS programme.

The result was a pilot project that ran from 2016 to 2018 in which almost 300 women across the country were provided with family planning, antenatal care, support during delivery, postpartum care and guidance on the prevention of mother-to-child transmission of HIV.

On 30 May, national stakeholders, including representatives of the Ministries of Foreign Affairs and Health and Population, civil society, academia and people living with and affected by HIV, gathered to highlight the key achievements, experiences and lessons learned from the pilot.

“I benefited from the project counselling service throughout my pregnancy. I started taking medicine, and, with follow-up, I had a child free from HIV, which I never thought was possible or an option,” said an Egyptian woman living with HIV.

The pilot project achieved outstanding results, reaching nearly double the number of people originally planned to be reached and building institutional expertise in sexual and reproductive health. Counselling and psychosocial support was provided by health professionals and supported by women living with HIV.

“This project is a continuation of the collaboration and fruitful partnership between UNAIDS and the Egyptian Government. We congratulate the Government of Egypt for addressing the needs of a highly marginalized population,” said Ahmed Khamis, the UNAIDS Country Manager for Egypt.

Dr Ahmed Khamis, UNAIDS Country Manager, gives the opening speech on the closing and final dissemination of key results of the “Enhancing Sexual and Reproductive Health of Women Living with HIV” pilot project; with Dr Alaa Eid, Under Secretary for Preventive Medicine, Ministry of Health and Population, H.E. Laurens Westhoff, Ambassador of the Netherlands in Cairo and Ambassador Seif-alla Kandeel, Director of UN Specialized Agencies, Ministry of Foreign Affairs (from left to right). Photo taken by Mohamed Ezz

The pilot programme was funded through financial support from the Embassy of the Netherlands in Egypt and covered the Giza and Gharbia Governates of Egypt and was later extended to the Dakahlia Governate.

“The Netherlands is strongly committed to curbing the spread of HIV worldwide as an integral part of our contribution towards the achievement of the Sustainable Development Goals. We are proud of our partnership with UNAIDS and the Egyptian Ministry of Health. The Netherlands Government is committed to participate in the next step,” said Laurens Westhoff, Ambassador of the Netherlands to Egypt.

As the next step, the Netherlands is finalizing an agreement for a scaled-up three-year project, doubling the number of women living with HIV reached.

“There is no silver bullet to combat HIV. It’s only through partnership that the challenges of awareness, attention and access to medicine can be tackled,” said Seif-Allah Kandeel, Director, United Nations Specialized Agencies, Egyptian Ministry of Foreign Affairs.

Twenty-five countries and 10 international organizations have pledged to respond to falsified and substandard medicines in French-speaking Africa.

On the sidelines of the 71st session of the World Health Assembly on 22 May, the Organisation internationale de la Francophonie (OIF) and UNAIDS, in collaboration with the World Health Organization and the Fondation Chirac, hosted a conference entitled Access to Quality Medicines and Other Medical Products in Francophone Africa, which brought together nearly 400 participants, including a number of health ministers. They adopted a declaration with commitments to advance access for all, especially the poorest, to assured-quality health products.

Thousands of people die each year because of falsified or substandard medicines, especially in many African countries, where up to seven out of 10 medicines don’t meet the quality standards required by international health regulatory agencies.

“Finding ways and means for better access to quality medicines and medical products in developing countries, especially in Africa, at all costs is now an emergency because, despite conventional international measures, the intensifying scourge of falsified medicines continues to wreak havoc among the poor,” said Patrice Talon, the President of Benin.

Michel Sidibé, the Executive Director of UNAIDS, agreed. He said, “There is an urgent need to support efforts to stop the entry into the market of falsified and substandard medicines everywhere, including African countries. Access to quality medicines is at the heart of the right to health for all and it is also a prerequisite for universal health coverage.”   

The signed declaration aims to foster mechanisms to assure the quality of all health products that reach the African market. Therefore, it calls for the strengthening of health regulatory capacities in the continent, paving the road for the local production of medicines.

OIF’s Secretary-General, Michaëlle Jean, would like the document to be the basis of an action plan. “We intend to raise this with all heads of state and government of the francophone area at the 17th Francophonie Summit in October, mobilizing them around concrete solutions and sustainable financing at the national, regional and international levels,” she said. 

Parliamentarians from across Africa are considering a historic resolution to promote the right to health and achieve targets on HIV, tuberculosis, malaria and other health emergencies, such as cervical cancer and hepatitis.

Michel Sidibé, the UNAIDS Executive Director, addressed the Pan African Parliament on 9 May to urge its members to express their firm commitment and determination to end the AIDS epidemic and deliver on the Abuja Declaration and the plan of action on achieving health targets in Africa. The plan of action resulted from a high-level parliamentary meeting convened in October 2017 by UNAIDS in partnership with the Pan African Parliament and the African Union.

“A Pan African Parliament resolution will help to achieve health targets in Africa. Parliamentarians, as champions in their communities, can help achieve these targets,” said Mr Sidibé.

The final decision of the parliament will be confirmed after the sixth ordinary session of the fourth parliament concludes on 18 May. The resolution will be the first of its kind for the Pan African Parliament since it commenced in 2004.

“AIDS is not over. We need to reach everyone who does not yet know that they are HIV-positive,” said Kgalema Motlanthe, former President of South Africa.

The Global HIV Prevention Coalition has launched its first progress report.

Taking stock of the progress made in strengthening political commitment for HIV prevention and reducing new HIV infections, the report shows that significant progress has been made since the launch of the Global HIV Prevention Coalition six months ago. National prevention coalitions have been established to accelerate and better coordinate responses, new and ambitious prevention programme targets have been set in many countries and HIV strategies that focus on prevention have been launched.

“There are many promising country examples across the coalition we can learn from,” said Sicily Kariuki, the Minister of Health of Kenya.

Good programme examples highlighted at the event include strong condom programmes in some southern African countries and high voluntary medical male circumcision coverage in several eastern African countries. Strong programmes for key populations, including in India and Ukraine, and pre-exposure prophylaxis being rapidly introduced and expanded in Brazil and Mexico, as well as in South Africa and Kenya, were also noted.

However, the progress report also shows that much still needs to be done. Policies on age of consent continue to represent major barriers to adolescents accessing services. Punitive laws and law enforcement practices hinder access by key populations.

“Every day, there are 1000 new HIV infections among young women and adolescent girls. Prevention programme gaps remain huge,” said Michel Sidibé, the Executive Director of UNAIDS.

For prevention efforts to be sustainable, civil society should be meaningfully engaged in all national prevention coalitions, and their expertise and comparative advantage in implementation used. HIV prevention also needs to be adequately funded.

“Four main reasons that were holding us back were identified when we formed the coalition: gaps in political leadership, policy barriers to effective prevention, gaps in prevention financing and lack of systematic programme implementation at scale. With the adoption of the Global Prevention 2020 Road Map we committed ourselves to address these issues,” said David Parirenyatwa, the Minister of Health and Child Care of Zimbabwe.

More than 200 delegates, including 11 ministers of health from coalition countries, as well as ministers from three additional countries that newly joined the coalition—Botswana, the Islamic Republic of Iran and Myanmar—attended the launch event, held on 22 May at the 71st World Health Assembly in Geneva, Switzerland.

A team of French researchers has succeeded in filming HIV infecting a healthy cell. UNAIDS spoke to Morgane Bomsel, Research Team Director at the French National Center for Scientific Research (CNRS), about the feat.

What motivated you to film HIV transmission?
Morgane Bomsel: HIV transmission has not been studied much and we had no precise idea of the exact sequence of events leading to HIV infection of genital fluids during sexual intercourse. Neither did we know how immune cells are infected and what the consequences are. The vast majority of new HIV infections are acquired via the genital and rectal mucosa; however, the outer layer, the epithelium, of those tissues varies and affects how HIV enters the body.

What were the challenges?

MB: The challenges involved building an experimental model that mimicked genital mucosa infected by genital fluids suitable for live imaging. We reconstructed in vitro human male urethral mucosa based on human cells, the surface of which had been engineered to be red, and an infected white blood cell (a T lymphocyte, the main infectious element in sexual fluids) that was engineered to be fluorescent green and in turn would produce fluorescent green HIV infectious particles.

We had to render the system fluorescent to be able to visualize it and track HIV entry in the mucosa by live fluorescent scanning. Finally, we had to devise a system to allow the microscope lens to visualize the contact between the cells. All of this, of course, was done in an extremely secure setting and all of us were wearing two pairs of gloves and a hat, a coat, glasses and a mask.

When did you know you had a breakthrough?

MB: Our eureka moment was when we captured on film the spillage of a string of viruses, like a gun showering bullets. This lasts for a couple of hours and then, as if the infected cell has lost interest, it detaches itself and moves on.

Please walk us through the video

MB: The HIV-infected cells are labelled in green and produce fluorescent viruses that appear as green dots.

What we see is the HIV-infected cell attaching itself closely to the outer layer, the epithelium, of healthy reconstructed cells of a genital tract mucosal lining.

White blood cells of the immune system, macrophages, that usually engulf foreign substances, debris or cancer cells are seen engulfing the red particles slightly moving next to the blue macrophage nucleus.

The HIV-infected cell approaches the surface of the mucosa and places itself gently on the surface. Owing to, or induced by, contact, the infected cell recruits preformed viruses towards the cell contact (the intense yellow green patches) and then starts to spit those preformed viruses as full infectious viruses that appear as green dots.

These green viruses penetrate the outer layer of the tissue by a process called transcytosis—a type of transcellular transportation. The viruses enter the cell and exit, still infectious, at the other side of the epithelial barrier. As a result, HIV penetrates the types of white blood cells responsible for detecting, engulfing and destroying foreign substances and infects them. Once inside the nucleus, the virus inserts itself in the genetic material, the DNA, and the blood cells that are meant to protect the body start to produce viruses.

Interestingly enough, the video showed that the production of viruses does not last very long. After three weeks, the infected white blood cells become dormant and a reservoir of white blood cells is formed.

What makes HIV particularly tricky to cure?

MB: Attempts to cure HIV have been very difficult because of the dormant infected white blood cells. Those cells are hard for the immune system to find and kill, and for the scientist to study. Antiretroviral medicines prevent the virus from spreading throughout the body and the immune system targets cells that are actively transcribing viral DNA. But because of the reservoir, these cells become a problem if a patient stops taking antiretroviral therapy. They can slowly awaken, allowing the virus to replicate freely.

Western and central Africa has faced many challenges, from conflicts and humanitarian crises to political instability and the devastating Ebola epidemics. At a time when the global response to HIV is accelerating, millions of people in the region are being left behind. Globally in 2016, 70% of all people living with HIV knew their HIV status, 53% of all people living with HIV were accessing treatment and 44% of all people living with HIV were virally suppressed. In contrast, the western and central African region lags behind, achieving only 42%, 35% and 25%, respectively, in 2016. The gap is considerable in that region: 4.0 million people living with HIV are not receiving treatment and 310 000 adults and children died from AIDS-related illnesses in 2016.

In order to share experiences, challenges and information on successful programmes, representatives of civil society organizations involved in the AIDS responses across western and central Africa gathered in Somone, Senegal, from 7 to 10 May. Technical and financial partners also took part in the discussions.

“Eighty civil society leaders from 17 countries in western and central Africa are eager to take up a central role in the implementation of the western and central Africa catch-up plan as actors of social change and political transformation,” said Patrick Brenny, the Director of the UNAIDS Regional Support Team for Western and Central Africa.

The participants developed innovative solutions to overcome barriers to national AIDS responses and to improve the unity and collaboration of local civil society organizations. They examined progress and setbacks in the implementation of national catch-up plans and shared experiences of violations of human rights related to HIV status and stigma and discrimination.

Consensus emerged that efforts should be focused on bridging the gaps in paediatric care and treatment, in particular in the context of the lack of social protection schemes for orphans and other children made vulnerable by AIDS. The region has seen a worrying trend in increasing mortality among adolescents living with HIV. Lack of access to comprehensive sexuality education, a high age of consent to access sexual and reproductive health information, services and treatment without parental agreement and taboos around youth sexuality were raised as some of the obstacles to be overcome.

Successful innovations and programmes with key populations and other vulnerable groups were shared. There was wide consensus about the role of community health systems to reach remote populations and vulnerable groups, while protecting confidentiality.

“It is high time that we increase investments to guarantee access to antiretroviral medicines, have better paediatric medicines, implement family testing approaches and scale up social protection programmes to protect all vulnerable mothers and children,” said Christine Kafando, Coordinator of the Hope for Tomorrow Association in Burkina Faso.

The participants will build on the progress made by organizing national dialogues around the catch-up plan for the region. The development of a regional platform for advocacy and technical support will be further discussed to enable stronger and more resilient civil society to play roles in national AIDS responses and other global health challenges.

“Each stakeholder gathered here plays a central role in their respective national AIDS response. Each brings invaluable experience to the table. We need to build on this energy to renew our commitment to work together for much needed breakthroughs for the region to bring HIV under control,” said Daouda Diouf, the Executive Director of ENDA Santé in Senegal.

One of the most watched events of the year got Cynthia Weber wondering: can the use by Sky News of artificial intelligence (AI) at the wedding of Prince Harry and Meghan Markle be a good thing?

For the first time in history, a news broadcaster used AI facial recognition technology during a live broadcast. Cynthia, a professor of international relations and gender studies at the University of Sussex, explained that using software to name wedding guests may be a nifty trick, but there are worries about the implications.

“Some claim that this technology can identify a person’s sexual orientation,” Cynthia said while speaking during an event for the International Day against Homophobia, Transphobia and Biphobia in Geneva at UNAIDS headquarters.

Referring to a Stanford University study that analysed more than 35 000 images on a United States dating website of white, able-bodied, 18–40-year-olds, the researchers compared their AI-generated sexual orientations against sexual orientations researchers found in dating profiles. The study claimed that AI facial recognition technology could determine a person’s sexual orientation with up to a 30% greater accuracy than people can.

Cynthia said that LGBTI advocacy organizations labelled the study junk science—the study used a skewed sampling in terms of race and age and the study equates sexual orientation with sexual activity. “The result is that the study’s artificial intelligence algorithm only finds what it was programmed to find: stereotypes about straights, gays and lesbians,” said Cynthia.

Cynthia believes that AI knowledge may generate opportunities in many fields, but sees far more risks and dangers than advantages for LGBTI people.

When AI meets facial recognition technology and a sexual orientation algorithm, at least four issues arise. First, privacy. In national and international law, a person’s face is not protected by privacy laws. That allows faces to be scanned and read by everyone, from governments to Sky News.

Secondly, accuracy. “In a world beyond the royal wedding, artificial intelligence facial recognition technology is far from perfect, even when it just tries to match names with faces, much less when it tries to match presumed sexual orientations with faces,” Cynthia said.

For Cynthia, the key issue is knowledge. How does a sexual orientation algorithm know better than an individual his or her sexuality? Cynthia considers the binary approach of code and computer-readable data not compatible with the vast gender and sexuality spectrum.

Finally, the issue of what the AI information will be used for worries Cynthia. “Let Sky News use it for wedding commentary, but what if the police use it in countries where homosexuality is outlawed?” Cynthia asked.

For Cynthia, AI and sexual orientation are not necessarily mutually beneficial. Cynthia understands that AI influences imagination and drives innovation, but believes that categorization of people usually introduces more harms than benefits.

Cynthia concluded by saying, “People have to make sure that artificial intelligence is ethically driven, not just technologically driven.”

The event was organized with the Swiss LGBTI Pride@Work association and UN Globe, a United Nations-wide LGBTI organization, and was held on 16 May.

A new US$ 30 million partnership to help end cervical cancer led by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the George W. Bush Institute and UNAIDS will accelerate life-saving efforts in eight African countries.

Studies show that women living with HIV are four to five times more likely to develop invasive cervical cancer. However, the disease is preventable through screening and early treatment of precancerous lesions. Early detection and treatment of cervical cancer can dramatically increase a woman’s chance of survival—women with preinvasive lesions have a five-year survival rate of nearly 100%.

Because of the high prevalence of HIV in sub-Saharan Africa, and because women in sub-Saharan Africa are not screened or treated as early or frequently as women in other parts of the world, cervical cancer remains the number one cancer killer of women in the region.

To address the disproportionate risk of cervical cancer among women living with HIV and the need for increased rates of screening and treatment in sub-Saharan Africa, PEPFAR the George W. Bush Institute and UNAIDS recently announced a new partnership—the Partnership to End AIDS and Cervical Cancer—designed to effectively eliminate cervical cancer deaths among women living with HIV in sub-Saharan Africa within a generation. The partnership will build on successful efforts over the past seven years of the Pink Ribbon Red Ribbon initiative and, pending Congressional approval, will be supported by an initial investment of US$ 30 million from PEPFAR.

“When we confront suffering—when we save lives—we breath hope into devastated populations, strengthen and stabilize society, and make our country and the world safer,” said President George W. Bush. “This week, we are announcing the next phase of our partnership with the United States President’s Emergency Plan for AIDS Relief and UNAIDS: a plan to effectively eliminate cervical cancer amongst HIV-positive women within a generation.”

The partnership will focus its work in eight sub-Saharan African countries where the burdens of HIV and cervical cancer are high—Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe. There are about 6 million women living with HIV in those eight countries. More than 100 000 women are diagnosed annually with cervical cancer in sub-Saharan Africa.

“The partnership will allow us to screen for, and treat, precancerous lesions among women living with HIV like never before,” said Michel Sidibé, the Executive Director of UNAIDS. “The partnership’s new strategy, which includes cervical cancer screening every two years for women living with HIV over the age of 30 years, aims to reduce cervical cancer incidence by 95% among this population in eight sub-Saharan African countries.”

The partnership will engage with governments in each of the countries to ensure that women and girls living with HIV are a priority in national cervical cancer prevention and control programmes. It will also leverage the powerful advocacy of first ladies, ministers, civil society, global health leaders and funders to improve implementation efforts and speed progress against the goal of eliminating cervical cancer.

“Thanks to the generosity of the American people, the United States President’s Emergency Plan for AIDS Relief has saved the lives of millions of HIV-positive women around the world,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “We must ensure these same women—mothers, daughters, aunts, and grandmothers—who are living with HIV and thriving do not succumb to cervical cancer.”

The new partnership builds on the successful efforts of the Pink Ribbon Red Ribbon initiative. Since its inception in 2011, Pink Ribbon Red Ribbon and its partners have screened more than half a million women for cervical cancer in Botswana, Ethiopia, the United Republic of Tanzania and Zambia, treated almost 32 000 women for precancerous lesions and vaccinated almost 150 000 girls aged 9–13 years against human papillomavirus type 2.

Calls to increase the number of trained and paid community health workers and reach more people with primary health care have been made for decades. However, countries are still struggling to expand the number of health workers serving in their own communities. This is despite overwhelming evidence of the gains made through such programmes in improving overall health, particularly maternal health and child health.

Rwanda’s investment in a combination of community-based insurance and community health workers led to the lowest maternal mortality in history for the country, showing that investments save lives.

“Africa bears 25% of the global disease burden, but has barely 3% of all health workers,” said Michel Sidibé, Executive Director of UNAIDS. “We need a shift in perspective to invest in community health workers to ensure healthy families and health security and to reach the people left behind.”

Forty years after the Declaration of Alma-Ata, which identified primary health care as the key to attaining health for all, global health leaders came together at an event to promote the effectiveness of community health workers by sharing their experiences and looking at ways of advancing the agenda on a global scale.

The event, convened by Ecuador and Ethiopia, was held on the sidelines of the 71st World Health Assembly in Geneva, Switzerland, on 21 May and joined together community health workers, ministers of health, programme managers, the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, Graça Machel, a co-founder of the Elders, and Mr Sidibé.

Sunil Kumar, a community health worker in India, gave his account of how important medical services are to people in remote communities. He explained how he managed to reach a pregnant woman in a remote area of India in the rainy season. Despite a dangerously overflowing river, he and his colleague went the extra mile to ensure that her baby was delivered safely—a stark reminder of the unique added value of community health workers.

The Ministers of Health of Ecuador, Ethiopia and Namibia and the Permanent Secretary of the United Republic of Tanzania talked about the successes and challenges they are facing in trying to expand the number of community health workers in their countries.

The State Minister of Health of Ethiopia shared a successful model that has been scaled up in the country. Ethiopia now has more than 38 000 paid and trained health extension workers following the 2004 launch of the health extension programme, financed by a mix of government and international donor funds. The programme has made significant contributions to declines in maternal mortality, improvements in hygiene and sanitation and a reduction in major communicable diseases.

“We are seeing momentum for universal health coverage,” said Mr Tedros. “Primary health care is both promotion and prevention and community health workers are the backbone.”

In July 2017, the African Union Commission launched an initiative to recruit, train and deploy 2 million community health workers by 2020, an initiative championed by UNAIDS. UNAIDS, in close collaboration with the World Health Organization and the United Nations Children’s Fund (UNICEF), recently supported the African Union Commission to undertake the first stocktaking exercise on the status of community health workers across the whole of Africa. The findings and recommendations will be submitted to heads of state during the African Union Summit in June 2018. UNAIDS is supporting countries to implement this important initiative.

Although positive steps have been made, many countries are still struggling to scale up. “In Namibia, we adopted the Ethiopian model, as it has been so successful,” said the Minister of Health of Namibia. “We trained 2000 people, which is small for a population of 2.3 million, and not all have been deployed due to budget cuts, inefficiencies and fraudulent use of resources.”

Other challenges cited by the speakers include transport issues, a lack of technology and communications support, such as smart phones, and political leadership at the very top levels.

“Health systems need to be built from the bottom up,” said Bent Høie, Norwegian Minister of Health and Care Services. “And that starts with community health workers.”

Stefan Swartling Peterson, Chief of Health at UNICEF, embodied the sentiment of the meeting by sharing a saying his professor, Francis Omaswa, former Minister of Health of Uganda, often reminded him of, “Health is made at home, hospitals are for repairs,” and stressed that community health workers cannot be alone, that systems, supply chains and data management are needed to make the programmes a true success. 

Urging for a global movement with every country making a commitment to increase the number of trained and paid community health workers, Graça Machel concluded by saying, “Let us not come back in 2030 and say we promised but we failed … it is not allowed.”