The best ways to respond to emerging epidemics have been outlined by leading policy-makers and health advisers during a side event entitled “Addressing global health emergencies: lessons from AIDS to Ebola, Zika and other emerging epidemics” that took place on 9 June.

Political leadership, the involvement of communities and a joined-up emergency response were highlighted as vital at the side event, which took place on the margins of the United Nations General Assembly High-Level Meeting on Ending AIDS, held from 8 to 10 June in New York, United States of America.

The response to AIDS and, more recently Ebola and Zika, was used as a starting point to explore what lessons could be learned.

The discussion was chaired by Deputy Executive Director of UNAIDS Luiz Loures and moderated by Laurie Garrett of United States think tank the Council on Foreign Relations.

Panellists at the side event included Sierra Leone’s Minister of Internal Affairs, Alfred Palo Conteh, the Executive Director for Gestos, Brazil, Alessandra Nilo, the Executive Director of Doctor Without Borders, Jason Cone, the World Health Organization’s Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, Ren Minghui, a professor from the Belgium Institute of Tropical Medicine, Marie Laga, and Monsignor Robert Vitillo, Special Adviser on Health and HIV to relief agency Caritas Internationalis.

The participants discussed how evidence from three decades of responding to HIV proved that responding to issues head-on within communities and engaging people living with HIV were essential.

The many similarities between HIV and outbreaks of Ebola and Zika allowed the participants to explore best practice when dealing with rapidly growing epidemics that are closely linked to poverty, inequality and gender.

The participants also examined how to overcome the fear, stigma and discrimination associated with epidemics so closely linked to sensitive topics, such as death and sexual behaviour.

The recommendations made at the side event included that steps should be taken to understand the cultural context of epidemics and that managing finances at the global level was necessary in order to tackle epidemics.

Other recommendations included integrating sexual, reproductive and human rights imperatives into the response, aligning new capacities to develop timely diagnostics, vaccines and medicines, ensuring that there are sufficiently qualified human resources and developing strong laboratory infrastructure and surveillance systems.

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Initiatives conducted in partnership with mass media outlets have proved to positively contribute to changing the HIV-related attitudes and behaviours of millions of people at very low cost. Edutainment designs characters and storylines to provide viewers with positive role models to relate to, often at a personal and emotional level.

At a side event on the margins of the United Nations General Assembly High-Level Meeting on Ending AIDS, being held in New York, United States of America, from 8 to 10 June, UNAIDS Brazil, Globo and other partners discussed how television, both web-based and other forms, can help educate people on issues related to living with HIV by focusing on people and not statistics.

Held on 9 June and entitled “New ways to engage youth to reach the UNAIDS Fast-Track Targets through edutainment,” the side event highlighted innovative ways of working with young people in Brazil. In the country, UNAIDS and Globo have started a partnership to reach young people and discuss a variety of issues, from HIV prevention to testing, treatment and the human rights of vulnerable populations and people living with HIV. UNAIDS has also partnered with the Brazilian Government to promote activism and the leadership of young people. Together, the country is implementing new ways to engage young people to reach the UNAIDS Fast-Track Targets.

The global commitment to ending the AIDS epidemic by 2030 will demand increased investment in innovative and creative approaches that are able to Fast-Track the response and reach young people and people left behind. Innovative and creative approaches are needed to reduce stigma around HIV and promote HIV testing, prevention, care and treatment.

At the event, young people from Brazil and Africa gave examples of how they can be engaged in the response to the AIDS epidemic. Alejandra Oraa, from CNN and UNAIDS Regional Goodwill Ambassador for Latin America and the Caribbean, and James Chau, from CCTV and UNAIDS National Goodwill Ambassador for China, spoke about their experiences in working with large media for outreach. 

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For three days, a UNAIDS video is being played on a giant screen in Times Square, New York, United States of America.

Coinciding with the United Nations General Assembly High-Level Meeting on Ending AIDS, being held from 8 to 10 June in New York, the billboard screening will put an AIDS message at the forefront of people’s minds in one of the busiest crossroads of the world.

The 30-second clip highlights the importance of taking a Fast-Track approach to ending the AIDS epidemic, with the tag line, “Together we can reach an AIDS-free generation.”

The billboard screening is part of a partnership for the AIDS response between the Chinese news agency Xinhua and UNAIDS that was first signed in September 2011.

The year’s screening follows on from a video message from UNAIDS, supported by Xinhua, being played on a Times Square billboard during the 2011 High-Level Meeting on HIV and AIDS. Other efforts carried out during the past years under the Xinhua–UNAIDS memorandum of understanding include global media campaigns to promote public awareness of HIV and support for World AIDS Day activities. In addition, Xinhua will work with UNAIDS to publish and distribute a children’s book on living with HIV in China.

Xinhua is the world’s largest news agency, with more than 170 offices overseas and 31 domestic bureaus.

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On 10 June, the last day of the United Nations General Assembly High-Level Meeting on Ending AIDS, held from 8 to 10 June in New York, United States of America, representatives of United Nations and women-led civil society organizations, young women and government leaders and women living with and affected by HIV, came together to inspire and move forward the role of women in the response to AIDS.

The breakfast event, entitled “#whatwomenwant”, was supported by UNAIDS and other partners and led by the ATHENA Network which represents 60 civil society partners from 25 countries dedicated to advancing gender equity and human rights in the global AIDS response.

The event was the culmination of a week of advocacy activities organised in the lead-up to the High-Level Meeting on Ending AIDS.  Athena hosted a large-scale, coordinated Twitter campaign called #WhatWomenWant and led a global consultation to hear what women want and identify the specific key actions needed to leverage a sea change in the AIDS response for women and girls.

Young leaders from Africa, the Caribbean, Latin America, and Eastern Europe called for building bridges across movements, sectors and leaders. They emphasised the interconnectedness between HIV and broader women’s issues, such as child marriage and gender-based violence. They also called for meaningful places at decision-making tables and women-centered and women-led research and innovation.  

In a lively session, participants shared personal views on the progress made to date and their views on what it would take to empower women and reach the goals of the 2016 Political Declaration on Ending AIDS by 2030. They explored options for stronger coordination and joint leadership to support women-led organizations and strengthen young women’s leadership in the HIV movement and beyond.

The Political Declaration strongly recognizes the importance of advancing gender equality and women’s empowerment as a human right and as critical to ending AIDS. This global political commitment is an unprecedented opportunity to focus on the specific vulnerabilities of young women and girls in all regions and to bring affected women to the centre of the agenda.

The new UNAIDS Strategy (2016-2020) is another example where commitments to gender transformative responses for human rights and gender equality have been centrally positioned. In order to meet the UNAIDS targets and the demands of what women want, sustained advocacy and accountability are essential.

The event concluded by calling for commitments to invest in young women’s leadership in order to bring sustainable change to the response to HIV.

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The key question of how the impending crisis in HIV treatment should be addressed dominated a panel meeting entitled “Getting ahead of the looming treatment crisis: an action agenda for reaching 90–90–90,” which met on 9 June at the United Nations General Assembly High-Level Meeting on Ending AIDS, being held from 8 to 10 June in New York, United States of America.

The panel discussion focused on the imperative of achieving the global 90–90–90 treatment target, whereby 90% of people living with HIV know their status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have a suppressed viral load. 

Although such targets are realistic and achievable, the panel members argued that there is still a long way to go. Despite tremendous gains in treatment coverage, the current level is not sufficient to prevent the epidemic from rebounding in many countries.

A number of issues were cited, including the fact that half of all people living with HIV are unaware of their status and therefore not on treatment; given this figure, the number of people accessing antiretroviral therapy is expected to approximately double over the next five years. The sustainability of the supply of affordable antiretroviral medicines is uncertain, with new, more expensive, second- and third-line regimens becoming increasingly necessary. In addition, the generic market is concentrated among too few producers, which may have implications for sustainability.

The panel members suggested a range of recommendations to avert the looming treatment crisis. They stressed that the next phase of the AIDS response had to recognize new realities, such as rising migration and conflict, competing health and development issues and changing donor priorities.   

Front-loading AIDS funding over the next five years was also advocated, with resources needed for ending the epidemic peaking at US$ 26.2 billion in 2020. Treatment must become more widely available and countries should support the development, production and delivery of high-quality medicines, using the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) to create generics. Treatment delivery also needs to be broadened, with greater decentralization (such as community-based service delivery) and better access to viral load monitoring, the panel noted.

The need for low- and middle-income countries to increase their domestic funding was also raised, along with the role of the international community in lending its support where necessary to reach the 90–90–90 treatment target as a sound investment for global health and sustainable development. 

During her remarks in the panel session, the United States Global AIDS Ambassador, Deborah Birx, announced a new US$ 100 million investment fund for key populations. Noting that although the 90–90–90 treatment target applies to everyone, to ensure access to all, the United States of America, through the President's Emergency Plan for AIDS Relief, would be taking action to ensure 90–90–90 for key populations. The new fund will support innovative, tailored, key population-led approaches to expand access to proven HIV prevention and treatment services so that the words “no one left behind” are translated into emergency action today.

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The 90–90–90 treatment target cannot be reached without a substantially greater involvement of a well-resourced and well-trained community health workforce, experts told a side event at the United Nations General Assembly High-Level Meeting on Ending AIDS, taking place in New York, United States of America, from 8 to 10 June.

Speakers at the side event, held on 9 June and entitled “90–90–90 and human resources for health,” emphasized that the 90–90–90 treatment target offers a road map towards the ultimate goal of ending the AIDS epidemic by 2030. However, shortages in human resources for health pose a grave threat to hopes for ending the epidemic as a public health threat.

Community health workers represent a potentially transformative mechanism for closing health workforce gaps and accelerating progress in scaling up HIV treatment and improving treatment outcomes. Kesetebirhan Admasu, Minister of Health of Ethiopia, described how the country’s health extension worker programme has substantially improved health-care access and helped make health services more sensitive to the needs of communities.

Community health systems are especially critical for ensuring access to essential health services among people who face challenges in accessing mainstream services, including members of key populations. Surang Janyam, of the Service Workers In Group in Thailand, explained how trained community health workers have expanded access to HIV services among sex workers, men who have sex with men and transgender people in Thailand and increased community ownership of the AIDS response.

Sigrun Mogedal, of the Global Health Workforce Alliance, said that the AIDS response should partner and coordinate closely with the many efforts already being undertaken to strengthen the health workforce. In 2016, the World Health Assembly approved a new global strategy for the health workforce, prioritizing the strengthening of community health systems. The Earth Institute of Columbia University is spearheading a global partnership to mobilize 1 million community health workers in Africa, and countries such as Ghana have taken important steps to train and deploy new cadres of community health workers.

However, the lack of growth in international HIV assistance potentially jeopardizes the world’s capacity to build a strong and durable health workforce to achieve the 90–90–90 treatment target, speakers in the session emphasized. Jeffrey Sachs, Director of the Earth Institute, and Stephen Lewis, Co-Founder of AIDS-Free World, called for urgent action to mobilize new resources for AIDS and to ensure that sufficient new funding is channelled to community systems.

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The AIDS epidemic will not be ended without efforts to end discrimination, respond to exclusion and advance social justice, according to a panel meeting held on 9 June during the United Nations General Assembly High-Level Meeting on Ending AIDS, taking place in New York, United States of America, from 8 to 10 June.

The panel, entitled “Leaving no one behind: ending stigma and discrimination through social justice and inclusive societies,” stressed that upholding the values of inclusion and social justice is fundamental to creating societies that advance dignity and share the benefit of wealth and health for all. It called for seizing the unparalleled opportunity offered by the 2030 Agenda for Sustainable Development and the newly adopted Political Declaration on HIV and AIDS to realize the vision of ending AIDS as a public health threat by 2030 in a manner grounded in the principles of equality, inclusion and respect for the rule of law.

The panel highlighted the efforts of civil society in demanding protection against stigma and discrimination and calling for justice, dignity and access to health services for all. Yet, panellist and speakers recognized that across the world, women and girls, young people, migrants, sex workers, men who have sex with men, people who inject drugs, transgender people and prisoners continue to be left behind because of discriminatory and punitive laws, policies and practices. Participants also expressed concern about restrictive legal and policy environments that hinder the work of civil society organizations in supporting the HIV response.

The panel called for moving from recognition of these challenges to actions for addressing them. It noted that an epidemic such as AIDS can be transformed into a pathfinder for addressing structural inequalities and vulnerabilities provided that all stakeholders translate their commitments to leaving no one behind into concrete programmes and funding for human rights.

The panel concluded with an urgent call for action on the following: ending discrimination in health care, education and the workplace; addressing intellectual property regimes that prevent millions of people from accessing life-saving HIV, hepatitis and other treatments; removing punitive laws that block effective responses for people living with HIV and other key populations; investing in human rights programmes and efforts by civil society; and setting clear goals with targets and indicators on ending discrimination, repealing punitive laws and advancing social justice.

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A panel meeting at the United Nations General Assembly High-Level Meeting on Ending AIDS, being held from 8 to 10 June, warned that the global commitment to end AIDS as a public health threat by 2030 cannot be met without increased funding, more efficiency and improved programme effectiveness.

Members of the panel, which met on 8 June and was entitled “Financing the end of AIDS: the window of opportunity,” argued that greater investment in the AIDS response needs to be front-loaded in the next five years and reach the US$ 26.2 billion needed by 2020 in low- and middle-income countries. Governments and development partners must increase their investments to close the nearly US$ 7 billion gap between the resources available for HIV in 2014 and the 2020 peak. This will avoid a looming funding crisis for treatment and prevention. 

According to the gathering’s political leaders, experts and representatives of international organizations and civil society, this extra funding will allow the world to meet the 2020 interim targets on the road to ending the epidemic. These targets include the 90–90–90 treatment target of 90% of people living with HIV knowing their status, 90% of people who know their HIV-positive status accessing treatment and 90% of people on treatment having a suppressed viral load, reducing new HIV infections to fewer than 500 000 and elimination of HIV-related discrimination.

It was argued that the AIDS response must spend increased funding wisely by adopting the Fast-Track approach of rapidly scaling up treatment and prevention services with more efficient and effective programmes. The panel also discussed mechanisms to facilitate development partners and low- and middle-income countries front-loading resources to reach the ultimate goal of ending the AIDS epidemic as a public health threat by 2030.

Beyond the call for more funding and better allocation of existing resources, other critical factors for the sustainability of the response were highlighted, including local production of antiretroviral medicines in Africa, improvement in the procurement of commodities through price negotiations and access and affordability of modern pharmaceuticals in all countries.

There was a strong call for the following: facilitating the transition of countries moving into higher-income brackets, including supporting community-based programmes; fully funding the needs of gay men and other men who have sex with men, people who inject drugs, sex workers, transgender people and prisoners, and particularly young people among those populations; investing in communities; and scaling up public–private partnerships.

The panel stressed forcefully that the cost of inaction for individuals, communities, countries and regions was simply too high and that the world could not afford to miss this window of opportunity to make funding sustainable and reinvigorate the HIV response over the next five years. 

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