(From left to right): UNDP Administrator Helen Clark; Chief Executive and Secretary of New Zealand’s Ministry of Foreign Affairs and Trade, John Allen; UNAIDS Executive Director Michel Sidibé; and Amanda Ellis, Deputy Secretary, International Development Group.
Credit: UNAIDS

The Administrator of the United Nations Development Programme (UNDP), Helen Clark, and the Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), Michel Sidibé, began a three day mission in New Zealand—the first joint mission by the two UN leaders in this Pacific country.

Highlighting the importance of continued vigilance in the AIDS response, Ms Clark and Mr Sidibé emphasized the leadership demonstrated by New Zealand in the HIV response and called on New Zealand to continue to play a strong role to achieve the targets of the 2011 UN Political Declaration on AIDS.

“I commend New Zealand for taking early, decisive action to keep the AIDS epidemic under control,” said Mr Sidibé in an address to staff at New Zealand’s Ministry of Foreign Affairs and Trade. “New Zealand can be the first country in the Pacific region to reach the UNAIDS vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths,” he added.

Speaking at the Beehive Theatrette in the New Zealand Parliament, Ms Clark emphasized the link between HIV and core issues of human development. “The world is making progress but we cannot end this epidemic if we keep AIDS in isolation,” said Ms Clark. “We must help countries to address the underlying drivers, like poverty and gender inequality, that put people at risk for HIV.”

The New Zealand mission includes meetings in Wellington with Prime Minister John Key and other high-level government officials, such as the Minister of Women’s Affairs and the Associate Minister of Health, Honourable Jo Goodhew, Minister of Pacific Island Affairs and Education, Honourable Hekia Perata, and Chief Executive Officer of the Ministry of Foreign Affairs and Trade, John Allen.

UNDP Administrator Helen Clark and UNAIDS Executive Director Michel Sidibé join Tane Waetford, Policy Officer, Asia Regional Division, Ministry of Foreign Affairs and Trade (far left) and Martin Wikaira, Director, Maori Policy Unit, Ministry of Foreign Affairs and Trade (far right) at a Powhiri greeting ceremony in Wellington, New Zealand, on 5 March.
Credit: UNAIDS

While in Auckland, Ms Clark and Mr Sidibé will visit the New Zealand AIDS Foundation, where they will meet representatives of civil society, people living with HIV and other partners involved in the AIDS response. On the occasion of 8 March, International Women’s Day, Ms Clark and Mr Sidibé will open new offices for Positive Women Inc.—a support organisation for women and families living with HIV and AIDS.

New Zealand is recognized for having taken early domestic measures to protect the health and human rights of vulnerable populations. In 1987, New Zealand was among the first countries to introduce needle—syringe programmes for people who use drugs, and in 2003, New Zealand decriminalized sex work. These initiatives were essential to prevent the spread of HIV among key populations. Nationally, HIV prevalence remains low at 0.1% of the population.

New Zealand also provides critical international leadership in the HIV response, with a strong focus on AIDS in the Pacific Island States—particularly in Papua New Guinea, which has the largest epidemic in Oceania.

Donor representatives interacting with civil society members at the community dialogue space.
Credit: UNAIDS/J.Ose

On Monday 5 December, discussions in the community dialogue space at the 16th International Conference on AIDS and STIs in Africa (ICASA) focused on financing the AIDS response. On this theme, UNAIDS and UNDP co-hosted the event ‘Donor dialogue session: Funding the grassroots and sustainable financing of the HIV response in Africa.’ The major part of the discussion revolved around the current economic situation and the fact that donors are decreasing their funding for AIDS.  The session allowed for direct interaction between donors and civil society representatives, and participants seized this opportunity to call for sustained funding for community organizations.

Set up as a panel of donor representatives, the audience asked panellists questions from the floor. Civil society participants were concerned about the cancellation of the Round 11 by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). As one member of the audience highlighted “we fear the consequences of discontinuing HIV treatment as a result of this cancellation.” The Global Fund representative Mark Edington, Director of Country Programmes, assured participants that the Global Fund is fully operational and committed to continue working with civil society organizations. Mr Edington also affirmed that “people already on ARVs are our top priority, and there is no question that we will maintain funding available for those already on treatment.”

Civil society representatives also asked how grassroots organizations could access funding given the current financial situation. Sheri Nouane Duncan Jones, HIV/AIDS Team Leader with USAID Ethiopia explained the ongoing change to their funding mechanisms. The organization is moving away from traditional umbrella funding—where international donor funds are transferred to grassroots organizations through bigger non-governmental organizations—to a direct funding through grant application to small local organizations. This approach is expected to cut intermediary fees as well as to increase effectiveness of the programmes funded.

Other issues addressed during the dialogue were related to strengthening accountability and transparency of civil society, its capacity to implement programmes and transform itself in a rapidly changing funding environment. Community members emphasized their need for capacity building on proposal writing to access funding. The lack of technical support available could jeopardize their future access to funding, participants said.

The session was moderated by Cheikh Tidian Tall, Executive Director of the African Council of AIDS Service Organizations. Representatives from the donor community that participated in the dialogue included Sheri Nouane Duncan Jones, HIV/AIDS Team Leader, USAID Ethiopia, Mary ODUKA, Senior HIV/AIDS Advisor, Irish AID, Kristina Kloss, German Back-Up Initiative, GIZ, Miriam Vuckovich, Technical Adviser on HIV/AIDS, GIZ and Mark Edington, Director of Country Programmes, the Global Fund to Fight AIDS TB and Malaria.

The community dialogue space at ICASA 2011 is dedicated to highlighting the successes and challenges faced by grassroots organizations and civil society in Africa. All the sessions open and dialogue based allowing for much more interaction with the panel members and the audience. The overall goal of the space is to provide a venue for civil society and people living with HIV to meet and interact with prominent leaders from governments, international organizations, UN agencies, the private sector and other groups from within the region and around the world.

Secretary-General Ban Ki-moon speaks to reporters on arrival in Busan, Republic of Korea, to address the Fourth High-Level Forum on Aid Effectiveness.
Credit: UN News

Some 3500 delegates, including heads of state, ministers, civil society, the private sector and leaders of international organizations have come together for the Fourth High-Level Forum on Aid Effectiveness in Busan, Korea, from 29 November to 1 December to review the impact of development aid and chart a bold course for how the future of development cooperation will support the achievement of the Millennium Development Goals.

Speaking at the opening, UN Secretary General Ban Ki-moon underlined the need to move towards a “new cooperation partnership” based on shared responsibility where traditional donors continue aid programmes despite the economic crisis; where countries receiving aid set clear development priorities, deliver on commitments and work more with civil society; and where emerging aid donors and the private sector increase aid efforts and commitments.

"Our agenda today is very clear," Ban said. "We are here to ensure that aid reaches those most in need, the most vulnerable people who we have to take care of."

Underlining how commitment to development assistance has helped to slow the spread of HIV and reduce child mortality, the Secretary General emphasized the urgent need to continue support for “highly productive multilateral initiatives such as the Global Fund to Fight AIDS, TB and Malaria.”

Towards a “new global partnership for development” the Secretary General stressed three principles as the basis for effective aid:  accountability, flexibility and ownership. 

“Countries that are accountable, countries that receive flexible aid, countries that have the most ownership -- will be best placed to achieve the best results,” he said.

New partnership for Africa’s development

In Busan on Tuesday 29 November, UNAIDS Executive Director Michel Sidibé stressed that the time is right for new paradigms for international development cooperation to transform the concept of aid effectiveness. Mr Sidibe spoke at a side event on the impact of development aid in Africa, organized by the New Partnership for Africa’s Development (NEPAD) and the United Nations Development Programme (UNDP).

“At this game-changing moment in the AIDS response, today’s development paradigms look tired and confused – no longer responding to the needs of a changing world,” said Michel Sidibé, UNAIDS Executive Director. “We need to broaden the discourse beyond a focus on just financial sustainability. A socially sustainable agenda for Africa must be agreed upon in Busan.”

Although sub-Saharan Africa remains the region worst-affected by HIV with nearly 70% of the 34 million people living with HIV worldwide, the countries of sub-Saharan Africa have the potential to lead the AIDS response as they have increased access to technology, economic growth and a growing workforce, he stressed.

Youth as ‘transformers’

Mr Sidibé also joined the Korean Minister of Education, Science and Technology, Dr LEE Ju-Ho, at the Youth Forum to hear the perspectives of young people on effective aid and development. The Youth Forum, hosted by the Korean government and organized by the Korean National Commission for UNESCO, addressed ways to increase young people’s participation in aid and development.

Speaking to young people at the opening of the Youth Forum, Mr Sidibé said, “You are not spectators in development architecture—you are transformers. You are the leaders of today - transforming the world and the way development is done through your bold ideas and the innovative use of technology.”

Calling on young people to engage in the development of UNAIDS’ new youth strategy, Mr Sidibé highlighted how social media is a powerful tool for development and innovation. UNAIDS is using crowdsourcing to empower young people, including young people living with HIV, to take ownership and develop the strategy online. To participate in this initiative, go to www.crowdoutaids.org.

Peer educators providing HIV prevention information during a community fair in Puntarenas.

José is a young AIDS peer educator in the Costa Rican port city of Limon and he is proud to share HIV prevention messages and tips on how to stay healthy with other young people. “It’s really great to see how at the end of a session the group knows more about HIV. We also have a better idea of how to protect ourselves and deal with our relationships more successfully,” he said. 

As one of more than 80 peer educators, between the ages of 18 and 24, José is taking part in an ambitious HIV prevention project in the cities of Limon and Puntarenas, which are among the most affected by the virus in Costa Rica. The educators have gone through extensive training and can provide educational and communication materials and tools to their counterparts in a lively and informative way.

The three-year programme which began at the end of 2008 is called Friendly education and health services to promote healthy lifestyles and prevent HIV and AIDS—or Giro 180 for short. Supported by UNAIDS, the programme is managed by its cosponsors the UN Development Programme (UNDP), the UN Children’s Fund (UNICEF), and the UN Population Fund (UNFPA). The UN bodies work alongside the country’s Vice-Ministry of Youth and the National Council on Public Policy for Youth.

The peer educators themselves have developed a number of the interventions, including using online games that feature questionnaires on HIV risk and a Facebook page. Youth carnivals and community fairs, board game evenings and artistic, musical and recreational activities are also being used.

“We did a fair in Villa Plata, a very poor place,” said Deiker, a youth promoter in Limon. “We gave out information, played and had fun. We were there, sharing experiences with the boys from morning till evening. And in the end the guys didn’t want to leave.”

 As well as providing young people with HIV information and life skills to make informed choices, the project also seeks to build the capacity of healthcare and educational institutions to attain these goals in a protective environment.

Some 73 000 adolescents in the two cities aged between 13 and 18 are the main beneficiaries and young people from around the country are also indirectly benefiting from the political and institutional advocacy and information campaigns launched by the project.

Such information campaigns are vital in a country where a 2008 study carried out by UNFPA and UNICEF, with support from UNAIDS, found that the majority of young people in Costa Rica were sexually active by the age of 16. The same study showed that fewer than 30% of young people in Limon and 17% in Puntarenas knew how to use a condom correctly.

However, things are changing. The programme has led to an increase in commitment from government authorities and decision makers. A number of local and regional institutions, such as the Department of Health in Limon, have committed themselves to broadening youth-friendly HIV services. In Puntarenas, schools have adopted the ‘Giro Junior’ intervention, dedicated to the development of specific strategies to challenge HIV, with guidance and support centers. The regional Ministry of Public Education has also prepared a set of guidelines for HIV prevention in schools, which will be binding throughout the region.

The team spearheading the programme hopes that it will become a flagship model. For at least one of the peer educators, Bizmark from Limon, they are enjoying making waves, “Older people might be a bit scared of us talking so openly, widely and directly. We are changing lives in perhaps the only way people can change, which is having fun while learning.”

Understanding the links between sustainability and equality is critical, says the 2011 Human Development Report

Progress in health and development in the poorest countries is in serious danger if the world does not make a concerted effort to reduce inequities, protect the environment and promote sustainability. This is the stark warning highlighted in the 2011 Human Development Report, launched on Wednesday by the United Nations Development Programme (UNDP).

Sustainability and Equity: A Better Future for All, explores in great detail the relationship between health, education, income, gender disparities, sustainability and social inequalities. Significant progress cannot be achieved in one area without progress in all. If such gains are not attained, the least developed countries could see themselves diverging significantly from global patterns of development by 2050. The ideas expressed in the document are very much intended to provide a key focus of debate in the run up to the 2012 UN Conference on Sustainable Development (Rio+20).

As the UNDP Administrator Helen Clark states in the report’s foreword, understanding the links between sustainability and equality is critical, “if we are to expand human freedoms for current and future generations.” She adds, “The remarkable progress in human development over recent decades cannot continue without bold global steps to reduce both environmental risks and inequality.”

According to the Human Development Report, sustainability does not touch only on the environment but on the very way we choose to live our lives, with full awareness that our actions will have potentially profound consequences for coming generations. 

A Better Future for All notes that although the majority of people across the globe are becoming healthier and living longer, sub-Saharan Africa has not seen the same decline in health inequality. This is especially the case in southern Africa which is still bearing the brunt of the HIV epidemic with adult prevalence exceeding 15 percent in several countries. The report highlights the need to address the social, educational and gender inequities to successfully respond to the AIDS epidemic.

Gender disparity, evidenced by a lack of access to reproductive health products and services for many of the world’s women, is also shown in the report to have a profound effect on health, environmental sustainability and poverty.

An expansion in reproductive health rights, health care and contraceptive access will not only benefit individual women and their families but could have a marked effect on slowing global population growth.  According to the report, some 215 million women in developing countries have unmet family planning needs. However, in every country where such needs are met and women have comprehensive reproductive options, fertility rates are at, or below, replacement level.

The report concludes that it is possible to implement programmes which have an impact on sustainability and equity, with benefits for both people who are most disadvantaged and for the environment itself. Such programmes have sustainability and equality etched into policy and programme design and reserve a critical space for the voices of the most deeply affected.

UNDP has commissioned the editorially-independent Human Development Reports each year since 1990, when its Human Development Index (HDI), a composite measure of health, education and income, first challenged purely economic measures of national achievement and called for consistent global tracking of progress in overall living standards.

Fiji's President Ratu Epeli Nailitikau reads the report Secret lives, other voices at the launch.
Credit: UNAIDS/Kim

At the 10th International Congress on AIDS in Asia and the Pacific a new study called Secret lives, other voices was launched. It explores sexuality, gender identity and HIV transmission risk in Fiji, and represents the first research of its kind to be conducted since 1998 among men who have sex with men and transgender people in the country.

The launch was attended by Fiji's President Ratu Epeli Nailitikau.

With more than 200 respondents, the research project engaged staff members and volunteers from the AIDS Task Force of Fiji's Amithi Project and the AIDS Council of New South Wales.

Conceived with the aim to inform the HIV response and the development of community-based activities, the research was conducted by members of the community.  Research staff included men who have sex with men and transgender people, from a variety of social and ethic background, who were involved in each stage of the process including planning, data collection, analysis and reporting.

The report found that men who have sex with men are at high risk of HIV in Fiji. Only 21.6% of respondents consistently used condoms during anal sex with a male or transgender partner in the previous six months. More than one in five reported never using them.

Although there are high levels of knowledge about HIV, with over 66% of respondents answering questions correctly about transmission, the knowledge is not translating to behaviour.

The study also explored transactional sex and found that two thirds of the respondents reported giving or receiving money, gifts or favours in return for sex, making this a common experience.

Of the respondents only 10% had taken an HIV test in the preceding 12 months and knew the results. Barriers to testing included confidentiality and privacy issues as well as respondents reporting judgmental attitudes by clinic staff.

Many of the study participants had experienced some form of stigma and discrimination. About two thirds felt unsafe and uncomfortable expressing their sexuality or gender. About 57% reported experiencing verbal abuse and a third had been physically hurt in the previous six months.

The report recommends that HIV prevention and health interventions should be culturally appropriate and focused on reaching different groups within the men who have sex with men and transgender community, many of whom self identify in different ways. Access to HIV testing that is friendly should be scaled up and health care workers need training to best support the needs of men who have sex with men and transgender people, according to the authors.

In addition, the report recommends a concerted effort to challenge stigma and discrimination and increase psychosocial and support services. Men who have sex with men and transgender people are also encouraged to develop mobilizing skills to make sure their voices are heard.

"With technical support from UNDP and ACON we were able to show that civil society has the capacity to complete in-depth research projects to a recognizably high standard," said Niraj Singh, Project Manager with the AIDS Task force of Fiji and co-author of the report.

"The AIDS Task Force of Fiji has a very clear vision of the priorities leading from research to action. We now have a baseline which will help us to design and implement effective programmes to reach a diverse range of men who have sex with men and transgender people in Fiji. This study represents a valuable contribution to ongoing national and regional efforts to ensure that these communities are better served and better protected," he concluded.

The Secret lives, other voices project was funded by the United Nations Development Programme (UNDP).

Migrant worker Sarath shares his experiences with the panel.
Credit: UNAIDS/Kim

There are still about 50 countries, territories and areas around the world that impose some form of restriction on the entry, stay and residence of people living with HIV. Such restrictions remain a key form of discrimination, affecting the rights and freedom of movement of many migrants living with HIV and would-be migrants.

A symposium held at the 10^th International Congress on AIDS in Asia and the Pacific on 27 August brought together expert panellists from various countries with and without HIV-related travel restrictions to discuss the experiences faced by migrant workers and by public health systems. Their aim was to put forward recommendations and concrete policy actions needed to eliminate travel restrictions for migrants living with HIV.

Organized by the Joint United Nations Initiative on Mobility and HIV/AIDS in South East Asia (JUNIMA) and sponsored by UNAIDS, UNDP and ILO, the panel was chaired by Clifton Cortez, the UNDP Practice Team Leader on HIV, Health and Development for Asia and the Pacific.

“HIV is not a condition that should determine whether you are allowed to work or not; however, some 15 countries in Asia and the Pacific impose some form of restriction on the entry, stay and residence of people living with HIV. We surely can be better than that,” said Mr Cortez.

Mr Cortez was joined by Dr Chanvit Tharathep, Thailand’s Ministry of Public Health, Ms Maria Lourdes Marin, Executive Director, Action for Health Initiatives (ACHIEVE), Inc. Philippines, and Dr Lee Hang-Sun from the Ministry of Public Health in South Korea.

Sarath, as a migrant worker, shared experience of the limitations imposed by travel restrictions with the panel: “Testing for HIV and deportation of people who test positive makes no sense neither from a public health perspective nor from a financial point of view. We generate a lot of economic benefits to both sending and host countries and usually fall between the cracks in accessing social services, especially when we are abroad.”

Reintegration of migrants

Ms Marin talked about the reintegration process when migrants deported for their HIV status return home. This is a real issue for the Philippines which sends large numbers of migrants overseas.  

“The reintegration process must be needs-based and responsive to specific contexts of migrants. It needs to be holistic, and address all the dimensions of HIV such as economic, political and psychosocial,” said Ms Marin. “To do that you need to have discussions taking into account all phases of the migration cycle, including pre-departure and post-arrival.”

Some countries hold that HIV-related travel restrictions are imposed to protect their nationals from ‘foreign’ diseases and to avoid increased healthcare costs.  This rationale was refuted by Dr Chanvit from Thailand, a country which does not impose HIV-related travel restrictions:

“By providing universal access to health care for all, including migrants, we have not experienced an overflow of the health care system by migrants. What we have seen however is that we are better able to control infectious diseases and give treatment and care to those that need it.”

Dr Lee shared the South Korea experience: “Some people in South Korea still believe that HIV is a virus that comes from abroad. I hope ICAAP will give us the opportunity to join hands with civil society and work together on addressing the misconceptions regarding HIV.”

The way forward

The panel explored a series of recommendations to eliminate HIV-related travel restrictions and to promote universal access for migrant workers living with HIV. These included:

• Harmonize national policies on HIV and migration, promote collaboration between relevant ministries and civil society groups and support sustained bilateral and multi-country dialogues between sending and receiving countries;
• Establish minimum labour standards and health rights for migrant workers, and ensure that there are protection and support systems for migrants in destination countries;
• Build the capacity of Asian source countries to effectively reintegrate returning migrant workers living with HIV.

JUNIMA brings together governments (including ASEAN Secretariat), leading NGO networks, and the United Nations family, to promote universal access to HIV prevention, treatment, care and support for migrant workers in South East Asia and southern China.

This is an updated version of a story first published at undp.org

Women living with HIV waiting for treatment at a hospital in Sudan.
Credit: UN/FRED NOY

Weak and unable to walk, Fozia Bullen, from Nagbaka village in South Sudan, had lost all hope when she arrived at Maridi Hospital, one of the few antiretroviral therapy centres in the country for people living with HIV. Her doctor said she had reached a critical stage of illness, with rashes, loss of appetite, and severe weight loss.

After one month of treatment, Ms Bullen was discharged in better health and continues taking medication at home. After four months of treatment, her rashes disappeared, and she put on a significant amount of weight, which enables her to carry out daily work, tend to her gardens, and provide for her family.

She is one of many people living with HIV in South Sudan, which is considered to have a generalized HIV epidemic, with an estimated prevalence of three percent.  

Under a five year US$ 27 million project of the Global Fund to Fight AIDS, Tuberculosis and Malaria, thousands of people in South Sudan are now receiving lifesaving HIV treatment.  The project brings together a range of partners including the United Nations Development Programme (UNDP), the World Health Organization (WHO), other UN agencies, the Southern Sudan AIDS Commission, the Ministry of Health, and NGOs.   

A total of 4,156 people living with HIV have been able to access treatment since 2008. The project, which begun in 2006, has established more than 20 treatment centres across the country.

There has also been significant progress in other key areas. As of March 2011 around 130,000 people had received voluntary HIV counselling and testing and more than 158,000 young people have been educated about the virus. This is a setting where, according to latest research, less than ten percent of people have comprehensive knowledge of effective HIV prevention methods.

The project’s notable successes in addressing the HIV epidemic in South Sudan have been achieved in a country impoverished by more than 20 years of conflict with the north. However, despite celebrations of South Sudan’s independence in July, the world’s newest nation remains fragile, with a lack of basic services and infrastructure, a depressed economy, nascent governance and legal systems, and a returning population of refugees forced to flee the country during the conflict. 

To support the AIDS response in South Sudan, UNAIDS is reinforcing its office in Juba in August 2011. Recently appointed UNAIDS country coordinator, Dr Medhin Zewdu is ready to take on her new job.

“National ownership is key to a successful and sustainable AIDS response,” said Dr Zewdu. “I look forward to advancing the agenda on AIDS in discussion with the government, and with the people on the ground including civil society and people living with HIV,” she added.  

In Sub-Saharan Africa, the region most heavily affected by HIV, legal, policy and social barriers, including stigma, discrimination, gender inequality and the criminalization of key populations at higher risk of HIV infection, continue to make people vulnerable to HIV and hamper the ability of individuals, communities and states to respond to the epidemic. This was the conclusion of the Regional Dialogue for sub-Saharan Africa, part of the Global Commission on HIV and the Law, held at the beginning of August in Pretoria, South Africa.

No taboo should be left unchallenged 

A significant breakthrough came from the pledge of participants to highlight and discuss all aspects of the legal environment relating to HIV, including laws and practices related to stigma and discrimination, access to affordable treatment, children and adolescents, women’s rights and gender-based violence.

“This regional dialogue is a great opportunity for us, as Africans, to confront the difficult issues including discriminatory and punitive laws that target sex workers and men who have sex with men, and other populations vulnerable to HIV,” said Bience Gawanas, African Union Commissioner for Social Affairs.

The criminalization of drug use, sex work and same-sex sexual relations was also confronted by the participants in a bid to challenge all taboos. This is remarkable as recent punitive legal and policy developments in a number of countries in sub-Saharan Africa  relating to the situation of members of key populations has raised concerns about the readiness of stakeholders in the region to confront this issue. Some 31 countries in the region criminalize sex work, and same-sex sexual relations constitute a criminal offence in at least 30 countries.

Legal and policy barriers act as obstacles to HIV responses in Africa

This regional dialogue is part of a series of seven consultations organized in all regions of the world to inform the Commission on the laws, policies and practices that represent barriers to effective responses to HIV. The Global Commission on HIV and the Law, launched by UNDP and UNAIDS in June 2010, was set up to make recommendations for possible means to address these barriers.

Recognizing the opportunity offered by the Commission to review and explore remedies to these challenges, civil society and government representatives came together from all parts of the region. 

“To be effective in the AIDS response we need to address the needs of the millions of Africans who because of fear, prejudice, entrenched legal, cultural and social values and norms do not have access to HIV services or cannot live full and dignified lives,” said Sheila Tlou, Regional Director of the UNAIDS Regional Support Team for Eastern and Southern Africa.

Holding governments accountable to commitments made

In the Political Declaration on HIV/AIDS, unanimously adopted during the June 2011 United Nations General Assembly High Level Meeting on AIDS, all Member States committed to “intensify national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV.” During the dialogue, representatives of people living with HIV, sex workers and men who have sex with men called upon parliamentarians, members of the judiciary, and other key government officials in the region to fulfil this commitment.

So far the dialogues of the Global Commission on HIV and the Law have been held in six regions, with the only outstanding session, which will focus on ’High Income Countries’, scheduled to take place on 16-17 September 2011 in the United States.

Following this consultation process, the Global Commission on HIV and the Law will develop actionable, evidence-informed and human rights-based recommendations for effective HIV responses that promote and protect the human rights of people living with and most  vulnerable to HIV. The findings will be announced in December 2011.

GENEVA, 21 June 2011—New public health recommendations from the World Health Organization (WHO) and partners aim to help policymakers and doctors scale up access to treatment and prevention services for HIV and sexually transmitted infections among men who have sex with men and transgender people. These are the first global public health guidelines to focus on these specific population groups.

There has been a recent resurgence of HIV infection among men who have sex with men, particularly in industrialized countries. Data are also emerging of new or newly identified HIV epidemics among men who have sex with men in Africa, Asia, the Caribbean andLatin America. Generally, men who have sex with men are nearly 20 times more likely to be infected with HIV than general populations. HIV infection rates among transgender people range between 8 to 68% depending on the country or region.

One reason for this is the stigma experienced by many men who have sex with men and transgender people. In many countries, criminalization of same sex relationships drives such relationships underground, making people afraid to seek HIV prevention and treatment services. WHO and its partners advise more inclusive approaches and suggest some practical ways to improve their access to HIV prevention, diagnosis, treatment and care services.

"We cannot imagine fully reversing the global spread of HIV without addressing the specific HIV needs of these key populations," said Dr Gottfried Hirnschall, WHO's Director of HIV/AIDS Department. "We are issuing these guidelines to help countries and communities scale up the services needed to reduce new infections and save lives."

"Men who have sex with men and transgender people everywhere face huge difficulties in accessing HIV services," said George Ayala, Executive Director of the Global Forum MSM & HIV (MSMGF), a key partner in producing the recommendations. "The guidelines both present evidence for effective prevention interventions for these populations and provide recommendations to help ensure that pervasive barriers like stigma and criminalization no longer stand in the way of life-saving services.” 

The new guidelines "Prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men and transgender people: Recommendations for a public health approach" provide 21 recommendations for actions to be taken by multiple stakeholders, in close cooperation with men who have sex with men and transgender people, including:

• For national policy-makers: To develop anti-discrimination laws and measures to protect human rights, and to establish more inclusive services for men who have sex with men and transgender people based on their right to health
• For health service providers: To offer HIV testing and counselling followed by treatment for patients with CD4 count 350 or below as recommended in the WHO 2010 HIV treatment guidelines
• For communities: To scale up behavioural interventions for the prevention of HIV and STIs among men who have sex with men and transgender people
• For affected individuals: Practice consistent condom use over choosing partners based on HIV infection status (sero-sorting)

"Urgent action is needed to ensure that the basic human rights of people most at risk of HIV infection are respected and that they have the information and tools to protect themselves against HIV and gain access to antiretroviral therapy if needed,” said Mariângela Simào, Chief, Prevention, Vulnerability and Rights, UNAIDS.

The WHO guidelines have been developed over the past year through global consultations involving public health officials, scientists, and representatives from donor organizations, civil society and health service providers. The new guidelines can be found at: http://www.who.int/hiv/pub/guidelines/msm_guidelines2011/en/ .