UNAIDS is deeply saddened by the death of the prominent AIDS researcher and activist Mathilde Krim. Ms Krim was a pioneer in AIDS research from the earliest days of the AIDS epidemic and a dedicated defender of human rights and justice.

Ms Krim was a research scientist, dedicated to increasing awareness around HIV. She was one of the Founding Chairmen of the Foundation for AIDS Research (amfAR), an organization dedicated to AIDS research, HIV prevention, treatment education and the advocacy of sound AIDS-related public policy.

Her activism, dedication and compassion were instrumental in influencing public policy mobilizing funds for AIDS research and protecting the human rights of people living with HIV or affected by HIV.

In 2000, Ms Krim was awarded the Presidential Medal of Freedom, the highest civilian honour in the United States of America. 

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UNAIDS and the Government of Australia have signed a new five-year strategic partnership agreement to advance efforts to respond to HIV in the Asia–Pacific region. The agreement will focus on promoting evidence-informed, sustainable and integrated approaches to responding to HIV that promote innovation and address human rights, discrimination and gender issues.

The agreement highlights a shared vision to end AIDS and builds on the strengths and experiences of both Australia and UNAIDS to form a collaborative partnership. This partnership will enable a robust and sustainable response to HIV which is integrated into the wider context of health and sustainable development in the Asia–Pacific region.

As part of the agreement, Australia will commit AUD 22.5 million (US$ 17.1 million) to UNAIDS over five years from 2018 to 2022 to support UNAIDS in achieving the targets, goals and vision outlined in the UNAIDS Strategy: On the Fast-Track to end AIDS.  

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Despite the scorching Abidjan heat, the Salam Plateau mosque stayed cool as imams, pastors, fathers and members of various religious groups along with women welcomed a UNAIDS delegation.

Imam Djiguiba Cissé gave an overview of his mosque and said that he and all the faith leaders gathered wanted to join UNAIDS in promoting HIV awareness.

Forty years of science and treatment have led to great progress in the AIDS response but now it's time to tackle stigma and discrimination, explained UNAIDS Deputy Executive Director Luiz Loures. Mr Loures reiterated that he needed faith leaders' help in making sure that violence against women is no longer tolerated and that men are better informed regarding HIV.

The imam said that compassion was a guiding principle of all faiths and that it should apply to faith leaders when they interact and care for people living with HIV. He also said that one of their objectives was to promote women. Women carry the greater burden of HIV globally and gender inequality is in large part responsible. Mr Cissé stressed that it was key to end violence against women and female genital mutilation.  Female genital mutilation is  prevalent in the north, north-eastern and western regions of Africa. Not only are there no known health benefits, it is painful and traumatic and can cause immediate and long-term health consequences to girls and women. The imam's final point to the congregation was to engage men to overcome some of these challenges and give young men a chance. More than 60% of Côte d'Ivoire's population is under 25 years of age, he explained, saying that more boys were resorting to migration or terrorism because they feel left out.

In January 2018, faith leaders led by Mr Cissé and with the help of UNAIDS are to attend an HIV awareness training encompassing the issues of stigma, status and empowerment. 

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Sitting across from the bustling main Geneva train station, the lime-green block structure called Quai 9 stands out. The building houses a supervised drug injection centre run by the non-governmental organisation,  Première Ligne. Quai 9 (track 9 in English) also provides primary health care services as part of its harm reduction drop-in centre to people who use drugs.

On the occasion of UNAIDS 41^st meeting mid-December of the Programme Coordinating Board, the Switzerland government organized a visit for UNAIDS board members.

The visit highlighted how addressing the needs of injecting drug users through a public health and human rights-based approach,  considerably reduces the risks of  HIV infection and links people to health care.

The Swiss Ambassador to the United Nations, Mr Valentin Zellweger recalled how in the 1980s and 1990s, Switzerland had one of the highest incidence of HIV in Europe among people who inject drugs. In response to the crisis, Switzerland, introduced a “four pillars” policy, which focused on prevention, treatment, harm reduction and law enforcement.

One of the outcomes was setting up drug injection centres and increasing collaboration between the police and health care clinics.

As a result, HIV infections among people who inject drugs in Switzerland dropped precipitously.

Earlier in the week, Ms Ruth Dreifuss, former President of Switzerland, Health minister and current chair of the Global Commission on Drug Policy, had addressed UNAIDS board members. Ms Dreifuss, who spearheaded the four pillars policy during her tenure, said the evidence that harm reduction and decriminalization of drug use spoke for itself. She urged member states to leave no one behind by ensuring that drug use is treated as a public health issue. That call was further emphasized by members of the NGO delegation. 

UNAIDS Deputy Executive Director Luiz Loures commended Switzerland for its innovative, multi-sectoral approach to harm reduction. He said that UNAIDS would continue advocating for evidence-informed, human-rights based AIDS responses such as Quai 9.    

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The 41st meeting of the UNAIDS Programme Coordinating Board (PCB) is taking place in Geneva, Switzerland, from 12 to 14 December.

At the opening, UNAIDS Executive Director Michel Sidibé gave an update on the progress made in the AIDS response and outlined the challenges and opportunities that lie ahead. He stressed that despite the progress made AIDS is not yet over and outlined the five key challenges that remain unaddressed—reaching the unreached, protecting young women and girls, ensuring that men have access to services, focusing on the regions that are lagging behind and addressing stigma, discrimination and criminalization.

During the opening session, Mr Sidibé also announced that Michel Kazatchkine will be the Special Adviser to UNAIDS on HIV, Tuberculosis and Hepatitis for Eastern Europe and Central Asia.

The thematic segment of the PCB meeting will take place on the last day and will focus on accelerating action to end discrimination in health-care settings. The participants will review the evidence of the effects of discrimination in health-care settings on efforts to reach the global HIV prevention and treatment targets and will identify programmatic actions to end such discrimination.

The 41th meeting of the PCB is being chaired by Ghana, with the United Kingdom of Great Britain and Northern Ireland acting as Vice-Chair and Japan as Rapporteur.

There is a consensus among political leaders, civil society and development partners that ending AIDS as a public health threat in Nigeria will require increased domestic funding.

In the past 10 years, Nigeria has made progress in its AIDS response. The number of people living with HIV on life-saving antiretroviral therapy in the country grew to more than one million by mid-2017. AIDS-related deaths have been reduced from 210 000 in 2006 to fewer than 160 000 in 2016. Although only 30% of people living with HIV in Nigeria are now on treatment, 81% of people on treatment are virally suppressed.

According to the Society for Family Health, Nigeria, spending on the AIDS response in Nigeria increased from US$ 300 million in 2007 to US$ 730 million in 2013. But the AIDS response has been largely sustained through external funding, especially from the United States President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In order to increase domestic funding for the AIDS response, efforts are under way for each of Nigeria’s 36 states to contribute up to 1% of their monthly allocations from the federal government to the response to HIV. The Government of Nigeria, with technical support from UNAIDS and the World Health Organization, is also establishing an HIV trust fund aimed at increasing private sector contributions from 2.1% in 2014 to 10% by the end of 2018.

Increases in domestic funding will boost efforts to diagnose the estimated two million people living with HIV in Nigeria who do not know their HIV status and are not yet on treatment. In December 2016, the President of Nigeria, Muhammadu Buhari, launched a Fast-Track plan using domestic resources to maintain 60 000 people living with HIV on HIV treatment and to ensure that an additional 50 000 people access treatment each year. 

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On 11 and 12 December, representatives of four populations at higher risk of HIV infection—people who inject drugs, sex workers, lesbian, gay, bisexual, transgender and intersex people and former prisoners—gathered in Kyiv, Ukraine, for the legal formalization of the National Platform for Key Communities and to agree on key priorities for advocacy and on how the platform will be managed and operated.

The platform’s priorities will include influencing policies and decision-making processes, the development of a package of HIV prevention services that respond to the needs of key populations and responding to discrimination.

The participants decided on the positioning, role and contributions of the platform in the national AIDS response, the implementation of a Fast-Track strategy and the form of an HIV prevention 100 days of action campaign. They also enthusiastically welcomed continued Dutch, UNAIDS and civil society collaboration and agreed on a unified strategic vision for the participation of civil society and the platform in key events, including the International AIDS Conference, to be held in Amsterdam, Netherlands, in 2018.

The three key advocacy areas for the platform will be:

• The participation of communities in decision-making on health, an effective response to HIV and tuberculosis and the protection of human rights.
• The provision of access to services for key groups focused on the needs of communities that are implemented by the communities and funded by national and local budgets.
• The protection of rights and the prevention of discrimination.

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Discrimination in health-care settings is one of the major obstacles to ending the AIDS epidemic as a public health threat by 2030. Evidence shows that discrimination in health-care settings is widespread across the world, seriously reduces the quality of life of people who experience it and impedes the use of health services, thus preventing people exercising their right to health.

In order to accelerate action to end discrimination in health-care settings, the UNAIDS Programme Coordinating Board—during its 41st meeting, which took place in Geneva, Switzerland, from 12 to 14 December—reviewed the available evidence of the effects of discrimination in health-care settings on the efforts to reach the global HIV prevention and treatment targets and identified programmatic actions to end such discrimination.

Often driven by stigma, discrimination in health-care settings may be manifested when an individual or group is denied access to health-care services that are otherwise available to others, or when care, treatment and/or medical procedures are refused or delayed on a discriminatory basis.

Evidence provided during the meeting shows that discrimination in health-care settings excludes or deters people from seeking health services for fear of stigma, judgemental attitudes or lack of confidentiality. It acts as a barrier to reaching the 90–90–90 targets and has negative impacts along the continuum of care, which encompasses HIV prevention, testing, treatment and sustained viral load suppression.

Where people cannot or will not access health services, they are less likely to be tested for HIV at all, let alone in a timely manner to ensure that they benefit from the early initiation of treatment. Similarly, where people living with HIV do initiate treatment, discrimination can lead to them being lost to follow-up and less likely to adhere to treatment.

Furthermore, health workers are also subject to the same drivers of discrimination as others, including negative attitudes towards people living with HIV, key populations and women and girls. Health-care provider surveys in Thailand reveal that attitudes about HIV among health facility staff may prevent them from adequately caring for people living with or affected by HIV. The attitudes include notions that HIV is a punishment for immoral behaviour, that most people living with HIV do not care if they infect other people and that it can be appropriate to sterilize a woman living with HIV, even without her consent. In some cases, health workers explicitly state that they would prefer not to provide services to members of key populations.

Solving these challenges and eliminating discrimination in health-care settings requires the implementation and scale-up of focused, coordinated, time-bound, evidence-informed, multisectoral actions.

The participants at the meeting agreed upon a set of programmatic approaches to reduce discrimination in health care, including the following:

• Programmes and other measures to eliminate discrimination in health-care settings must be based on the evidence. Discrimination must therefore be monitored, measured and tracked. In particular, it is important to gauge both the experiences of service users and the attitudes and practices of service providers, as well as to monitor the existence and implementation of national-, local- and facility-level non-discrimination policies.
• As part of a comprehensive strategy to eliminate discrimination in health-care settings, countries should provide pre-service and in-service education to the health workforce. This allows health workers to develop human rights and gender equality competencies and strengthens the understanding of medical ethics and workers’ rights, roles and responsibilities in relation to discrimination in health-care settings.
• Countries should review and strengthen laws to prohibit discrimination in the provision and distribution of health services and provide access to remedies for individuals whose rights have been violated, as well as penalties for the perpetrators. Eliminating formal discrimination rooted in laws and policies is one part of the solution. However, states must also put in place measures that protect people living with HIV and members of key populations in and beyond health-care settings.

The participants agreed that addressing stigma and discrimination, including in health-care settings, is a fundamental requirement for achieving the Fast-Track Targets set for 2020 and the promise of the 2030 Agenda for Sustainable Development of leaving no one behind.

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A global ministerial conference held in Moscow, Russian Federation, on 16 and 17 November that united more than 1000 participants, including 75 ministers and 114 country delegations, concluded with the adoption of the Moscow Declaration to End TB.

The Moscow Declaration to End TB is a new commitment to increase multisectoral action and enhance accountability in the global TB response towards ending tuberculosis (TB) by 2030. The declaration will also inform the first United Nations General Assembly High-Level Meeting on TB, in 2018, which will seek to advance commitments to end TB from heads of state and government.

The declaration outlines the importance of international action to address key areas to respond to TB: sustainable financing, pursuing science, research and development and the establishment of a multisectoral accountability framework.

The conference, the First World Health Organization Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: a Multisectoral Response, was opened by the President of the Russian Federation, Vladimir Putin. It was attended by high-level United Nations leaders, including Amina J. Mohammed, the United Nations Deputy Secretary-General, Tedros Adhanom Ghebreyesus, the World Health Organization Director-General, and Michel Sidibé, the UNAIDS Executive Director.

TB is the world’s leading cause of death from infectious disease—in 2016, 1.7 million people died from the disease—and has profound economic and social consequences. The public health crisis of multidrug-resistant TB continues to deteriorate and TB is the leading cause of death among people living with HIV. 

During the conference, Mariam Avanesova, who was treated for multidrug-resistant TB in Armenia from 2010 to 2012 and represents the organization TBpeople, the Eurasian network of people living with TB, handed over the #StepUpforTB petition. The petition is an urgent call for health ministers in key TB-affected countries to ensure that their TB policies and practices are in line with international standards, as defined by the World Health Organization, including testing and treatment of TB and its drug-resistant forms. Initiated by Médecins Sans Frontières and the Stop TB Partnership, the petition has been signed by more than 30 000 people from 120 countries.

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Young sex workers, transgender people, lesbian women, gay men and other men who have sex with men, people who inject drugs and people living with HIV from across Africa came together on 2 and 3 December for a preconference meeting ahead of the 19th International Conference on AIDS and STIs in Africa (ICASA), being held in Abidjan, Côte d’Ivoire, from 4 to 9 December.

The meeting, entitled Onto the African Map: Youth Key Populations and HIV, was a way for young people to express the challenges that they face, from a lack of opportunities to discrimination and social and legal injustices.

Those barriers make young members of key populations particularly vulnerable to HIV, violence, harassment and a lack of hope. Despite these challenges, attention to the protection of human rights and to the health needs of key populations remains limited in national HIV responses.

The meeting reviewed those challenges and identified key areas of action and recommendations that were compiled in the joint declaration adopted at the meeting. The declaration calls, among other things, for urgent action to stop violence, harassment and other human rights violations towards young people and key populations. It further calls for the participation of young key populations in health, policy and other decision that affect them and stresses the need to increase programmes and investments for services that address the needs of young key populations.

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