GENEVA, 7 June 2013—The Joint United Nations programme on HIV/AIDS (UNAIDS) welcomes the recent announcement by the World Health Organization (WHO) that for the first time a non-surgical device (PrePex™) has been pre-qualified for the purpose of adult male circumcision for HIV prevention.

There is compelling evidence that medical male circumcision reduces sexual transmission of HIV from women to men by 60%. WHO and UNAIDS urge countries with high HIV prevalence and low levels of male circumcision to expand access to safe, voluntary medical male circumcision as part of their HIV prevention efforts. 

However, many countries are facing challenges in scaling up voluntary medical male circumcision as for HIV prevention, in particular due to the shortage of surgically trained and skilled providers to perform the current conventional surgical procedure.

In comparison to the surgical procedure, PrePex™ does not routinely require injectable anaesthesia or suturing, and safe use has been demonstrated by appropriately trained physicians and mid-level providers with surgical back-up as needed.

“This kind of innovation that may contribute to improving efficiency, access, and safety, while increasing demand for voluntary medical male circumcision is very welcome,” said Michel Sidibé, Executive Director of UNAIDS. “It could have a significant impact on HIV prevention efforts in areas with high HIV prevalence and low levels of male circumcision if uptake increases.”

Since voluntary medical male circumcision programmes for HIV prevention started in 2007, an estimated 2 million men have undergone circumcisions for HIV prevention in Eastern and Southern Africa. UNAIDS estimates that voluntary medical male circumcision has the potential to prevent an estimated 1 in 5 new HIV infections in the region by 2025. However, programmes will need to be significantly scaled-up to maximize public health impact.

Medical male circumcision provides partial protection to men from heterosexual transmission, and WHO and UNAIDS recommend that it be firmly placed in a combination approach to prevent HIV infection that includes the correct and consistent use of male and female condoms; a reduction in the number of sexual partners; the promotion of safe sexual practices such as avoidance of penetrative sex; treatment for sexually transmitted infections; and the provision of antiretroviral therapy for people living with HIV who are eligible for treatment.

GENEVA, 2 March 2012—An estimated one in four AIDS-related deaths each year is caused by tuberculosis (TB). A majority of these deaths occur in Africa, where the mortality rate from HIV-related TB is more than 20 times higher than in other world regions. Reducing the dual burden of these twin epidemics will require the scale-up of collaborative TB-HIV activities.

UNAIDS welcomes the updated HIV-TB policy guidance from the World Health Organization (WHO), released today. This revised guidance is timely as countries work towards a 50% reduction in TB deaths among people living with HIV by the year 2015—a key target enshrined in the 2011 United Nations Political Declaration on AIDS.

“People living with HIV are more likely to develop TB and need integrated health services,” said UNAIDS Executive Director Michel Sidibé. “Integration is not just an ideal, but a necessity.”

In recent years, countries have made considerable progress in addressing TB and HIV. Between 2005 and 2010, the number of people living with HIV screened for TB increased 12-fold, from nearly 200 000 to 2.3 million. In 2010, more than 60% of HIV-positive people who developed active TB were identified and treated for TB. An estimated 910 000 lives were saved between 2005 and 2010 as a result of the scale-up and implementation of collaborative HIV-TB activities.

The new WHO guidelines include recommended actions to further reduce the dual HIV-TB burden. The main elements of WHO’s new policy include:

• Routine HIV testing for TB patients, people with symptoms of TB, and their partners or family members;
• Provision of co-trimoxazole, a cost-effective medicine to prevent against lung or other infections for all TB patients who are infected with HIV;
• Starting all TB patients with HIV on antiretroviral therapy as soon as possible, regardless of immune system measurements;
• Evidence-based methods to prevent the acquisition of HIV for TB patients, their families and communities.

Geneva, 3 February 2012—The World Health Organization (WHO) will later this month issue further guidance on the reported link between hormonal contraceptives such as the pill, injectables, implants and HIV.

On 31 January and 1 February, WHO convened a technical consultation WHO and Partners Stakeholders' Meeting on Hormonal Contraception and HIV Infection: A review of the evidence and implications for service delivery and priority research, made up of 53 experts from 20 countries to review the body of published evidence on the use of hormonal contraceptives and HIV acquisition, progression, and transmission. The review was prompted by new findings in 2011 that implied a possible increase in HIV infection among women at risk of HIV who use hormonal contraception, or increased transmission to an un-infected partner when a woman is living with HIV and using hormonal contraceptives.

The outcomes of this meeting will now be assessed by the WHO Guidelines Review Committee (GRC) –  the body that oversees the production of WHO public health guidelines for countries. The Committee will meet on 15 February and announce its recommendations the following day.  

However, WHO guidelines clearly state, and call on health service providers to remind their patients, that neither hormonal contraceptives nor intrauterine devices (IUDs) offer protection against HIV or other sexually transmitted infections (STIs). Condoms are the mainstay of dual protection against both unwanted pregnancy and STIs including HIV.

As outlined in WHO's recent guidance in 2009, based on the best evidence available at that time, The Medical Eligibility Criteria for Contraceptive Use, 4th Edition 2009 (MEC) says that women at high risk of HIV infection and those who are living with HIV can safely use hormonal methods.

All WHO information can be found at: www.who.int

More information on the WHO Department of Reproductive Health and Research can be found at: http://www.who.int/reproductivehealth/about_us/en/

UNAIDS, UNDP and WHO encourage countries to use the flexibilities as set out in the TRIPS agreement to lower costs and improve access to HIV treatment

GENEVA, 15 March 2011—The Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Programme (UNDP) and the World Health Organization (WHO) are deeply concerned about the long-term sustainability of access to affordable HIV treatment.

In a new policy brief launched today, UNAIDS, UNDP and WHO urge countries, where appropriate, to use the intellectual property and trade flexibilities set out in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), and the Doha Declaration on the TRIPS agreement and public health, in order to reduce the price of HIV medicines and expand access to people most in need.

“We are seriously concerned about the future of HIV treatment programmes,” said Paul De Lay, Deputy Executive Director, Programme, UNAIDS. “Only about one third of people in need have access to treatment. In the current economic climate even sustaining that over the long-term will be a challenge. Countries must use all the means at their disposal, including the TRIPS flexibilities, to ensure sustainability and the significant scale up of HIV services to reach people most in need.” 

At the end of 2009, nearly 15 million people were estimated to be in need of antiretroviral treatment for HIV and 5.2 million people had access to the life-saving therapy.  

Over the last 10 years the annual cost of a first-line antiretroviral regimen for low-income countries decreased by almost 99%––from more than US$ 10 000 per person in 2000 to less than US$ 116 for the least expensive WHO-recommended first-line regimen in 2010. However, prices are still too high for many low- and middle-income countries, especially for second-line regimens.

"Millions of people in developing countries now depend on a steady supply of affordable first-line treatment for HIV. If their treatment is interrupted, which can lead to drug resistance, these patients will have to switch to a second-line regimen. That can be at least six times more expensive than the first-line regimen," said Dr Gottfried Hirnschall, Director of WHO's HIV/AIDS Department. "Making full use of trade flexibilities and other cost reduction strategies for quality medicines is now more important than ever."

The challenge is further exacerbated by an uncertain economic climate. In 2009, funding for HIV was lower than in 2008. This is putting current treatment programmes under increased strain because of reduced budgets and competing priorities. In addition, proposed bilateral and regional free trade agreements could limit the ability of developing countries to use the TRIPS flexibilities. Governments in both developed and developing countries should ensure that any free trade agreements comply with the Principles of the Doha Declaration. 

Jeffrey O’Malley, Director of UNDP’s HIV Practice said, “Using TRIPS flexibilities will allow countries to issue compulsory licences and to use other mechanisms provided by the TRIPS Agreement and Doha Declaration to obtain access to affordable generic antiretroviral medicines. This means a country could produce generic medicines at a lower cost or, if it does not have manufacturing capacity, import lower-cost, generic medicines from another country.”

Brazil issued a compulsory license for efavirenz through the TRIPS flexibilities which brought the price down by more than two-thirds, from US$ 1.60 per dose to US$ 0.45 for the generic version. Such price differences have enormous implications for the ability of national authorities and other service providers to deliver antiretroviral treatment to people in need.

Despite the opportunities provided by the TRIPS flexibilities, many countries have yet to amend their laws to incorporate them. UNAIDS, UNDP and WHO will continue to support countries, on their request, to increase access to treatment and provide technical assistance to implement the TRIPS flexibilities to scale up access to antiretroviral medicine.

UNAIDS and WHO launched the Treatment 2.0 initiative in 2010 to accelerate access to cheaper, more effective and tolerable drug combinations and diagnostics. Efforts must be maintained to spur much-needed innovation in developing new medicines and to support new intellectual property approaches. Incorporating and using the available TRIPS flexibilities will also be key to expanding access to HIV treatment in the coming years.

GENEVA, 10 December 2010—The World Health Organization (WHO) has endorsed a new diagnostic test that can diagnose tuberculosis (TB) and multidrug-resistant tuberculosis in less than two hours compared to the current standard test which can take up to three months.

The new rapid diagnostic test could result in a doubling in the number of HIV-associated TB cases diagnosed in areas with high rates of TB and HIV and a three-fold increase in the diagnosis of patients with drug-resistant TB.

Tuberculosis is one of commonest causes of illness and death among people living with HIV. TB and drug-resistant TB are especially difficult to diagnose in people living with HIV and many people die before the diagnosis can be confirmed and treatment started.

“This is a significant and welcome breakthrough for the response to HIV and TB,” said Michel Sidibé, Executive Director of UNAIDS. “The new test offers increased hope that we can achieve our ambitious target of halving TB deaths in people living with HIV by 2015 and save the lives of hundreds of thousands of people living with HIV. This is an example of Treatment 2.0 in action.”

In a new UNAIDS Strategy 2011-2015, endorsed this week by UNAIDS Programme Coordinating Board members, UNAIDS committed to halving TB deaths in people living with HIV by 2015.

See http://www.who.int/tb/features_archive/new_rapid_test/en/index.html for more information on the new diagnostic test.

GENEVA, 23 November 2010––The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) welcome new research published today showing that an antiretroviral drug combination, taken daily as a prophylaxis, in conjunction with use of condoms, reduces the risk of HIV infection by an average of 43.8% for HIV-negative men and transgender women who have sex with men.  

UNAIDS and WHO congratulate the iPrEx study team for the exemplary conduct of this complex multi-site, multi-language trial.

Men who have sex with men are often marginalized, hard to reach, and have poor access to HIV prevention services. New data from 43 countries show that slightly more than half of such men benefit from HIV prevention programmes. In addition, nearly 80 countries criminalize same-sex relations.

“This positive result is going to give hope to millions of men who have sex with men and help them protect themselves and their loved ones,” said Michel Sidibé, UNAIDS Executive Director. “This new tool can be a valuable addition to current HIV prevention approaches and help bring about a prevention revolution.”

The iPrEx study enrolled 2499 men in six countries, primarily in South America. Volunteers who took a daily dose of tenofovir/emtricitabine (TDF/ FTC) as oral pre-exposure prophylaxis (PrEP) were less likely to become infected with HIV than those who took the placebo. Those who took the pill consistently had higher effectiveness in preventing HIV infection.

"The trial opens exciting new prospects. It shows that oral pre-exposure prophylaxis can reduce the risk of HIV infection in men who have sex with men. We look forward to further examining these data to consider how we can best use this tool to enhance HIV prevention when used in combination with other prevention such as condom promotion in this population at higher risk," said Dr Margaret Chan, WHO Director-General.

The results from the study constitute proof of concept of the safety and partial effectiveness of oral PrEP. This study also showed the potential effects of combination prevention approaches—combining consistent condom use, frequent HIV testing, counselling, and treatment of sexually transmitted infections with pre-exposure prophylaxis for maximum prevention gains.

The announcement today complements results from the CAPRISA trial released earlier this year. That study found a vaginal microbicide gel containing tenofovir used before and after sex to be 39% effective in preventing new HIV infections in women.

The iPrEx trial is part of efforts to develop new HIV prevention options for people at risk of HIV exposure. In addition, on-going studies testing the use of similar drugs to prevent HIV infection will provide more safety and effectiveness data from diverse populations including heterosexual women, serodiscordant couples, and people who inject drugs.

UNAIDS and WHO strongly advocate combination prevention as the most effective strategy to reduce HIV transmission. This includes correct and consistent use of male and female condoms, delaying sexual debut, having fewer partners, avoiding penetrative sex, male circumcision, reducing stigma and discrimination, and the removal of punitive laws. The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. The iPrEx study findings provide hope that men who have sex with men may have an additional means to protect themselves against HIV in addition to condoms.

UNAIDS and WHO will work with the study team and convene experts and key stakeholders to assess implications of these results for potential safe and effective delivery of PrEP as an additional HIV prevention tool for men who have sex with men. Close clinical evaluation, regular HIV testing, counselling to support pill-taking behaviour and safer sex, and safety monitoring are likely to be key components of effective PrEP programming.

The trial team at each study site will now provide access to the drug combination to all study participants, including those in the placebo group. This is in line with published good participatory practice guidelines and ethical standards for biomedical HIV prevention trials. UNAIDS and WHO welcome the efforts of the study teams to gather information on what implementation strategies for safe and appropriate PrEP work best.

First time results from a South African study show that a gel containing an antiretroviral drug—when used as a vaginal microbicide—was found to be 39% effective in reducing a woman’s risk of becoming infected with HIV during sex.
 
VIENNA, 19 July 2010—The results announced today at the XVIII International AIDS conference in Vienna showed a significant reduction in risk of HIV infection in women who used a new generation of microbicide gels, one that contains the antiretroviral drug tenofovir. It also showed a significant reduction in genital herpes, a common viral sexually transmitted infection, which itself increases the risk of acquiring HIV infection.

This landmark proof of concept study was completed by the Centre for the AIDS Programme of Research in South Africa (CAPRISA). The gel was found to be both safe and acceptable when used once in the 12 hours before sex and once in the 12 hours after sex by women aged 18 to 40 years. Use of the gel reduced HIV infection by 39% and herpes simplex virus-2 infection by 51%.

“We are giving hope to women. For the first time we have seen results for a woman initiated and controlled HIV prevention option,” said Mr Michel Sidibé, Executive Director, UNAIDS. “If confirmed, a microbicide will be a powerful option for the prevention revolution and help us break the trajectory of the AIDS epidemic.” 

Nearly 20 years of research have gone into microbicides that can be controlled by a woman, independent of her partner. This microbicide study could open new possibilities for HIV prevention. 

"We welcome the findings of the CAPRISA study. All new advances in HIV prevention, particularly for women are exciting. We look forward in seeing these results confirmed. Once they have been shown to be safe and effective, WHO will work with countries and partners to accelerate access to these products", said Dr Margaret Chan, Director-General of WHO.

WHO and UNAIDS congratulate CAPRISA, a designated UNAIDS Collaborating Centre for HIV Prevention Research, on the successful completion of the study.

About half of the people living with HIV in the world are women. In sub-Saharan Africa more women are infected than men. HIV is a major cause of maternal mortality.

Given high levels of ongoing HIV transmission to young women in high prevalence settings, it is urgent now to confirm these results so that a safe and effective tenofovir gel can rapidly be made available to women who want it.

In addition to rapidly moving to additional trials to confirm results, key issues that need to be addressed include: determining requirements for the approval by national drug regulatory authorities of this new indication for tenofovir; operations research on how to deliver and sustain product supplies within combination prevention programmes; determining the frequency of HIV testing; and accelerated studies to expand knowledge on the safety of the product particularly in young women (below 18 years of age) and pregnant women.  

To stimulate and prioritize rapid action, WHO and UNAIDS will convene an expert consultation in August with women’s health and HIV prevention advocates, scientists, microbicide research teams and product developers, and public health experts to discuss the next steps with the product. Given the important contribution and leadership role of the women who participated in the study, South African scientists, advocates and policy makers in implementing the study of tenofovir gel, the consultation will be held in South Africa.

Dubai, 29 June 2010 - At a high-level policy dialogue organized by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO) and the World Bank, senior officials from government, donor agencies, development partners and civil society today launched a consensus statement calling for an accelerated regional response to the HIV epidemic in the Middle East and North Africa.

The statement reaffirmed the goal of universal access to HIV prevention, treatment care and support—a commitment enshrined in the 2006 Political Declaration on HIV/AIDS. While recognizing recent gains, the statement outlined a number of key recommendations to bolster the HIV response in the region. These include:

• wider access to HIV prevention;
• free and equal access to antiretroviral treatment and care for all in need;
• improved data and surveillance on the HIV epidemic, particularly for populations at high risk of HIV infection; 
• increased domestic and external funding for the AIDS response;
• the elimination of stigma and discrimination against people living with HIV;
• the removal of political and legal barriers that block an effective AIDS response; and
• the involvement of civil society and people living with HIV in the AIDS response.

The two-day policy dialogue, held under the patronage of HH Sheikh Maktoum Bin Mohammed Bin Rashid Al Maktoum, Deputy Ruler of Dubai, in collaboration with Dubai Police, cast a rare spotlight on an epidemic that is seldom highlighted in the region.

Addressing conference participants, Lt General Dhahi Khalfan Tamim, Commander-in-Chief of Dubai Police, emphasized the importance of a coordinated HIV response. “AIDS knows no boundaries or limits, and has no nationality,” he said. “Unifying the efforts of all stakeholders involved is crucial to halt the spread of AIDS in the region.”

HIV remains a highly stigmatized health condition in the region. In many settings, stigma and discrimination are preventing affected communities from accessing the HIV services they need. “I am here today to ensure that the voices of all those affected by HIV are heard,” said Egyptian actor Mr Amr Waked, a UNAIDS Regional Goodwill Ambassador who attended the meeting. “Social stigma and discrimination in this region must be urgently addressed.”

In his opening remarks, Mr Tim Martineau, UNAIDS Director of Programme Effectiveness and Country Support, noted that focusing resources on key populations—such as injecting drug users, men who have sex with men and sex workers—can change the course of the epidemic in the region. “Universal access goals are achievable if we want them to be,” he said. “We can break the trajectory of the epidemic in this region through strong leadership, a focus on human rights and effective health systems.”

Based on UNAIDS estimates, about 412 000 people were living with HIV in the region at the end of 2008, up from about 270 000 in 2001. However, to date, a lack of reliable data has hindered a clear understanding of HIV dynamics and trends in the region. “The Middle East and North Africa stands as the only region where knowledge of the epidemic continues to be very limited, inaccessible, and subject to much controversy,” said Akiko Maeda, Manager for Health, Nutrition and the Population Sector in the Human Development Department at the World Bank.

According to a new report developed by the World Bank, WHO and UNAIDS, the region has low HIV prevalence in the general population, with the exception of Djibouti, Somalia, and southern Sudan. Most HIV infections occur in key populations at high risk of infection. The report, entitled “Characterizing the HIV Epidemic in the Middle East and North Africa,” is the most comprehensive scientific synthesis of HIV spread in the region since the beginning of the epidemic.

Though all countries in the region are providing antiretroviral medications free of charge, most are falling far short of the goal of universal access to treatment. At the end of 2008, only 14% of the estimated 68 000 in need of treatment were accessing it. “Most people living with HIV do not know their HIV status,” said Dr Jaouad Mahjour, Director of the Division of Communicable Disease Control in WHO’s Eastern Mediterranean Region. “This remains the biggest challenge to expanding antiretroviral therapy in the region. Wider access to voluntary and confidential HIV testing and counselling tailored to the needs of most-at-risk populations is critical.”

Geneva, 27 April 2009 – The World Health Organization (WHO) is coordinating the global response to the confirmed human cases of swine influenza A/H1N1 and is monitoring the corresponding threat of an influenza pandemic related to this situation.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) is working closely with its cosponsor WHO to evaluate the risks the H1N1 virus may pose to people living with HIV and will provide guidance as more information becomes available

For the latest information from WHO on swine influenza, visit http://www.who.int/csr/disease/swineflu/en/index.html. This page is being updated daily at 16h00 Central European Time (CET).