Photo credit : UNAIDS\H. Vincent\Avecc

For Ugandan mother Margaret Namusisi, violence and HIV infection are constant threats. “There are times when I tell [my husband] to use a condom but he refuses. That causes disputes. So I have sex with him so that he will provide for the children and won’t fight,” she said¹. “The co-wives are dying one by one. He’s still having sex with me without a condom. If I tell him to use a condom there is such a big fight.”

Margaret’s experiences are far from unusual. For millions of women across the world, violence or the threat of violence is an every day reality. Recent research by the World Health Organization reveals that in some countries more than half of all women experience sexual violence by an intimate partner.

And for many of women, violence dramatically increases their vulnerability to HIV infection. Studies from Rwanda, South Africa and Tanzania show up to three-fold increases in risk of HIV among women who have experienced violence compared to those who have not. Violence or fear of violent reaction makes it difficult or impossible for many women to abstain from sex, to get their partners to be faithful, or to use a condom. For the same reason, women are often deterred from accessing HIV prevention, testing, treatment and care services

In South Africa, national youth surveys show that 33% of young women report they are afraid of saying no to sex and 55% have sex when they do not want to because their partner insists. More alarming still, between 20%-48% of adolescent girls aged 10-25 report their first sexual encounter was forced.

“Wherever you find violence —whether it's physical, psychological, or sexual —there will be AIDS. HIV entered my life through violence, as it has for so many, and we must actively commit to bring this to an end," said Violeta Ross Quiroga, National Chair of the Bolivian Network of People Living with HIV/AIDS (REDBOL)

In an effort to stem violence against women the Center for Women’s Global Leadership launched the ‘ 16 Days of Activism Against Gender Violence’ in 1991. Running every year from 25 November – 10 December, this international campaign highlights the fact that millions of women in every society around the world face violence every day, most often at the hands of husbands and partners, and within the so-called safety of their homes and families.

“The 16 Days Campaign brings together an incredible range of individuals and organizations to call for one thing: the elimination of violence against women,” said Sarah Russell of the UNAIDS-led Global Coalition on Women and AIDS. “The campaign is getting bigger by the year, and its message starker.”

In the past two years, the campaign has underscored the intersections between domestic violence and HIV.

“Not only does forced sex make women more liable to infection, but the fear of violent male reactions – physical and psychological - prevents many women from going to find out more about HIV,” said Russell “It discourages them from getting tested and stops them seeking treatment.”

That’s why the Global Coalition on Women and AIDS has made eliminating violence against women a priority, calling on governments the world over to enact and enforce laws that prevent violence against women, and develop strategies so that those who uphold the law know how to apply it and support survivors of violence. The Coalition also recommends that national AIDS plans integrate strategies to reduce violence against women, and link violence prevention efforts with mainstream HIV prevention and treatment services.

¹  Interview with Human Rights Watch, 2003

Links:

16 Days of Activism web site 
Global Coalition on Women and AIDS, section on violence

Photo credit : WHO

Tuberculosis (TB) is one of the biggest killers of people living with HIV and at least one third of the 39.5 million people estimated to be living with HIV around the world are likely to be infected with the TB bacteria. As a result of chronically poor investment in global TB control a new strain of TB is emerging that has become resistant to most of the available anti-tuberculosis drugs. Known as extensively drug resistant TB (XDR TB) this strain has serious implications for people living with HIV as it is almost untreatable in many of the countries where it is occurring leading to very high death rates. WHO and UNAIDS, together with other actors working on TB and HIV issues are stepping up action to stop the spread of TB and this deadly new strain.

TB is an infection which usually affects the lungs and is spread, like the common cold, through the air from an infectious person coughing, sneezing or even speaking. One third of the world’s population is infected with TB but only 5-10% of people who are infected with TB actually develop TB disease during their lifetimes. However, co-infection with HIV makes TB disease much more likely and one in ten people infected with TB who also have HIV will develop TB disease each year.

TB is treatable and can usually be cured in people living with HIV, however some strains of TB bacteria have now acquired resistance to one or more of the antibiotics commonly used to treat them; these are known as drug-resistant strains. Treatment for these infections is much longer and much more expensive. The recent outbreaks of tuberculosis that is resistant to almost all of the available TB drugs are giving serious cause for concern as this extensively drug resistant strain (XDR TB) is virtually untreatable when it occurs in people living with HIV and has a very high death rate.

UNAIDS has been following the developments closely. “We need to rapidly ensure prompt diagnosis and effective treatment of TB for people living with HIV in order to prevent drug resistance from developing and spreading,” said UNAIDS’ HIV/TB advisor, Alasdair Reid.

TB drug resistance arises mainly because of inadequate TB control, poor patient or clinician adherence to standard TB treatment regimens, poor quality drugs or inadequate drug supplies. People living with HIV are particularly vulnerable to developing drug-resistant TB because of their increased susceptibility to infection and progression to active TB.

At the 37th Union World Conference on Lung Health held in Paris in November 2006, the interaction between TB and HIV and the threat of extensively drug resistant TB featured prominently in the agenda. The serious implications of the new strain of XDR TB for people living with HIV were highlighted at a special plenary session held during the conference. Dr Kevin De Cock, Director of WHO HIV/AIDS Department said, “The recent emergence of a cluster of cases in South Africa has demonstrated the high mortality that XDR TB can have when associated with HIV infection. Countries with a high prevalence of HIV have been responding quickly to draw up plans for managing and preventing drug-resistant TB and this is welcomed.”

Because of the serious threat that TB and especially XDR TB poses for people living with HIV, UNAIDS and the WHO HIV and TB departments are joining forces to encourage a coordinated and concerted global effort to control TB in people living with HIV.

WHO’s Global Task Force on XDR TB have recently published a report outlining measures needed to urgently combat extensively drug-resistant XDR TB. It follows the announcement by WHO and its partners that US$ 95 million will be required to implement the recommendations in the report, to address the threat of XDR-TB in 2007 in southern Africa. WHO have also released new guidelines on how to improve the diagnosis of TB in people living with HIV.

Links:

Access WHO new guidelines.
Frequently asked questions about Tuberculosis and HIV.

WHO TB
Stop TB partnership
Presentations from the Union meeting on XDR TB can be viewed through the Kaisernetworks link on the Union website.
International Union Against Tuberculosis and Lung Disease

UNAIDS launched the new joint UNAIDS/WHO report, AIDS Epidemic Update 2006, featuring updated global and regional AIDS estimates and new trends in the epidemic’s evolution on 21 November 2006.

Key findings of the report will be presented, including:

• New evidence showing drop in HIV infection rates in several countries and among young people.
• However, global AIDS epidemic continues to grow, with some evidence of resurging epidemics.
• New data suggests where HIV prevention programmes have not been sustained and/or adapted as  epidemics have changed
• infection rates in some countries are staying the same or going back up.
• HIV prevention and treatment programmes need to be sustained, adapted and focused to reach those most at risk.

Executive Director of UNAIDS, Dr. Peter Piot, Ms. Karen Stanecki, UNAIDS Senior Epidemiologist and Dr. Kevin De Cock, Director of the department of HIV/AIDS at WHO during the launch of the 2006 AIDS epidemic update.

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Executive Director of UNAIDS Dr. Peter Piot presenting the report.

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UNAIDS Senior Epidemiologist, Ms. Karen Stanecki addressing the press

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Dr. Kevin De Cock, Director of the department of HIV/AIDS at WHO during the press conference.

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Executive Director of UNAIDS Dr. Peter Piot illustrating some of the information contained in the update.

View photo gallery of the 2006 epidemic update launch in Germany and Denmark

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All photo credit : O. O'Hanlon

Photo credit : UNAIDS\O. O'Hanlon

The United Nations Secretary General Kofi Annan urged the international community to continue to “fight to bring the global AIDS epidemic under control” as he visited UNAIDS in Geneva on Monday 20 November.

“In a short quarter of a century, AIDS has drastically changed our world. At least 25 million people have died of it; almost 40 million live with HIV today. AIDS, tuberculosis and malaria make up the deadliest triad the world has known,” he said, on his final visit to the UNAIDS Secretariat in his capacity as United Nations Secretary General.

“But at the same time, there is more than ever reason for hope. We can see how much things have changed, how the world is joining forces,” he added.

During his term in office Kofi Annan has been a pioneer in the AIDS response calling it ‘a personal priority’. “Even as I leave the office of the Secretary General, I assure you I will continue to fight AIDS,” he said, as he officially inaugurated the new UNAIDS/WHO building which will house both the UNAIDS Secretariat and the HIV, TB and malaria departments from WHO.

UNAIDS Executive Director Peter Piot underlined the importance of the Secretary General’s contribution and commitment to the AIDS response. “ If the world is now increasing acting against AIDS it is in no small part because of the leadership of Secretary General Kofi Annan,” he said “I trust you will remain an AIDS activist as I know your commitment is a passion way beyond your duty as Secretary General,” he added.

During his visit to the new UNAIDS/WHO building – designed by Baumschlager and Eberle architechts – the Secretary General also met with several artists who’s work on and around AIDS is displayed around the new building. He then visited the UNAIDS conference room which is named after him in recognition of his exceptional contribution to the AIDS response.

“This house will not only bring UNAIDS and WHO closer together. It will also be a meeting place for ideas, a centre for dialogue, a forum bringing together people and organizations, in the UN and beyond, to strengthen the global response against AIDS, TB and malaria. In this way, the building will be a nerve centre in our mission to reach the Millennium Development Goals and build better lives for people in the 21 st century,” he said.

Also speaking at the opening of the UNAIDS/WHO building were H.E.Ms Gunilla Carlsson, Swedish Minister for International Development Cooperation and Chair of the UNAIDS Programme Coordinating Board; Dr Anders Nordström, Acting Director General of the World Health Organization, H.E Mr Blaise Godet, Ambassador, Permanent Representative of Switzerland to the United Nations Office and other International Organizations in Geneva and Mr Mark Muller, State Councillor of Geneva (Conseiller d’Etat chargé du Département des constructions et des technologies d’information, Conseil d’Etat de la République et Canton de Genève).

Read: 
Speech by UNAIDS Executive Director, Dr. Peter Piot   (PDF, 30 Kb)
Speech by WHO Acting Director-General, Dr. Anders Nordström   (PDF, 30 Kb)
Allocution by Ambassador Blaise Godet  , Mission of Switzerland to the UNOG and other I.O. (PDF, 256 Kb), on the occasion of the UNAIDS HQ inauguration ceremony in Geneva on November 20, 2006

Every morning Buddhist Monk Maytryjit gets up at 3:45 am to meditate for one hour. Afterwards, he walks through the streets of Vientiane in the Lao Peoples Democratic Republic to collect his food alms.

However, this October he took time out of his usual routine to catch a flight to Pakse to attend a workshop convened by UNAIDS Cosponsor the United Nations Development Programme (UNDP) entitled Leadership for Results, which brought together more than 100 representatives from several provinces including Buddhist monks, government ministries and people living with HIV.

UNDP’s Leadership for Results training workshops aim to develop the capacity of local leaders to transform the response to AIDS by promoting leadership at all levels. A series of workshops were held, the final one in Pakse where the leaders attending formed seven “break through” groups in charge of developing proposals for a transformed response to AIDS in the country. The “break through” initiatives focused on increasing HIV prevention among women living in rural settings, improving access to condoms within the Army and increasing access to information on HIV through radio.

Ms. Setsuko Yamazaki, UNDP Resident Representative, a.i. said, “The rationale behind the Leadership for Results programme is to encourage the formation of strong leadership on AIDS related issues within all sectors, beyond those traditionally involved in the epidemic’s response.”

“This involves stimulating a deep-rooted shift within individuals, organizations and communities, to enable them to see AIDS from a new perspective, identify new possibilities and take action,” she added.

As a follow up to the workshop, the group committed to carrying out ten HIV prevention pilot projects at bus stations, markets and villages, with the aim of reaching out to thousands of people. Using radio programmes and loudspeakers, Monk Maytryjit and his group will also begin disseminating AIDS information during religious ceremonies, including one of Laos’ most significant religious festivals, the Pha That Luang (The Great Stupa or Sacred Reliquary) that is held in November.

“According to Buddhist philosophy one needs to follow the right path and an important part of our life-skills is to treat every person equally. It is important therefore to reduce stigma against people living with HIV in Laos and to help their families,” said Monk Mayrtyjit.

All photo credit : Yasmin Padamsee/UNDP

Increasing access to HIV prevention, treatment, care and support services for drug users and their partners is crucial to addressing the issue of growing HIV infections related to injecting drug use in the Middle East and North Africa region.

This was the overwhelming conclusion reached by regional representatives from law enforcement agencies, national AIDS programmes, NGOs, researchers, community representatives, people living with HIV and UN organizations who joined at a regional workshop on the issue of HIV and drug use in the region, held in Cairo, Egypt from 5 – 8 November.

Throughout the 3-day discussions, participants from the Arab countries, Afghanistan, Iran and Pakistan affirmed that drug use is an important risk factor in facilitating spread of HIV that calls for immediate action. Joint efforts of police, national AIDS actors, NGOs, drug users and of people living with HIV were recognized as fundamental elements in the prevention of HIV among drug users and their partners.

While significant efforts are being undertaken in a number of countries to reach out with HIV preventive services to drug users communities, limited capacities coupled with discrimination against drug users hamper implementation of wider-scale programmes.

“From my personal experience and my field work on reducing harm related to drug use, I suggest training more drug users and ex-drug users –to build their skills in order to promote and implement [HIV preventive] programs in the region,” an ex-drug user and outreach worker said in the workshop.

New initiatives for building capacities of civil society actors on implementing harm reduction measures and networking in the region were discussed and examined.

“Participation in this workshop has allowed an exchange of international experiences among NGOs and governments, and a discussion of the strategic approaches to planning at the national level to protect against the harms and risks of drugs and related HIV. It has created cooperation between [national stakeholders]…and encouraged civil society actors to assist and support alternative programs for drug users,” police participants from one of the Gulf countries said.

As part of the workshop, UNAIDS and UNODC launched the finalized Rapid Situation Assessment on Drug Use and HIV in Algeria and Morocco, as well as facilitate consensus on programmatic follow up for all participating countries. WHO and the International Harm Reduction Association launched a project on strengthening the role of civil society in harm reduction for injecting drug users in the Middle East and North Africa.

Although the main mode of HIV transmission in the Middle East and North Africa remains unprotected sexual contact, injecting drug use is an increasingly important factor in the region’s epidemics.

"Towards Universal Access to Prevention, Treatment, Care and Support in the West and Central African Region”

The renewed commitment to universal access to prevention, treatment, care and support undertaken by countries across the world, has paved the way in West and Central Africa to more inclusive dialogue among partners, galvanizing consensus around the core challenges currently obstructing the national response, and strengthening joint determination to scale up national programmes. 

The process of scaling up towards universal access in West and Central Africa has demonstrated the positive impact that broad and collaborative partnerships can provide, bringing together actors from government, civil society, (including people living with HIV, faith-based organizations, women’s groups, networks of health NGOs, youth associations, community based organizations), the media, the private sector, and bilateral and multilateral partners. This broad partnership set the backdrop for informed and open discussion on central themes of the national consultations, for example, raising issues around the importance of prevention as a means to ensure the sustainability of treatment provision.  

The UNAIDS Regional Support Team in Dakar has extensively supported the meaningful involvement of civil society which has been of varying but increasing frequency/intensity, In several countries such as Burkina Faso, Mali, Nigeria and Senegal, civil society has been actively involved in both the target setting and review processes of national strategic planning, ensuring the critical input of West African civil society into regional and global fora. This participation was ensured at the Brazzaville regional consultation and the Abuja Heads of State Summit, but more significantly, enabled African civil society to contribute to “ Africa’s Common Position to the UN General Assembly Special Session on HIV/AIDS” June 2006.  

Significant momentum has built up on target setting and its follow up, facilitated by technical and financial support provided by the UNAIDS country and regional offices, the UN Country Team and UN Theme Group . Seventeen of the twenty countries who have held national consultations to date have set targets towards scaling up, with countries raising the bar of aspiration by setting far more ambitious goals for 2010, in line with the 2001 Abuja Declaration and the UN High Level Meeting of June 2006.  

Progress made in West and Central Africa testifies to the central importance and utility of a strong strategic plan as the vehicle for reaching ambitious targets. Thirteen countries in all have developed nationally agreed roadmaps for scale-up over the next five years (2006-2010). Evidence suggests that those countries able to harmonize target setting with the strategic planning cycle, encountered far less difficulties in establishing targets than those who undertook a separate process. A harmonized strategic planning approach ensures that partners operate in accordance with national priorities, supporting the principles enshrined in the Three Ones and Global Task Team recommendations. In addition, it has been widely recognised that countries will only succeed in scaling up towards universal access if the critical obstacles identified during the country consultations are addressed through the national HIV strategic plans, and are complemented by regional and global level policy action.

Countries in the region have nevertheless encountered several challenges in the target setting and planning processes. In some cases, target setting has been hindered by a lack of available and reliable data, and further support is needed to establish one national M&E system, including a common database accepted and accessible by all partners. In addition, countries have struggled to cost their revised annual workplans, a process completed by six countries to date. Particular attention is needed to scale up technical capacity in this area to elaborate detailed costed annual work plans. Continued and sustained technical and financial support will be needed, for national governments and country-based civil society, to accelerate the national response .

The Regional Support Team in Dakar and the Country and Regional Support Department of UNAIDS Geneva will continue to provide technical and financial support to countries towards scaling up including the finalization of target setting and planning processes. In addition, the RST will also continue to work with the regional civil society networks in West and Central Africa to empower their respective member organization networks to play their role in the national AIDS response and to help them identify more effective means of communication and representation at key regional and global fora and institutions.

Operational guidelines for setting targets  

Although the main mode of HIV transmission in the Middle East and North Africa remains unprotected sexual contact, injecting drug use is an increasingly important factor in the region’s epidemics.

The spread of HIV among drug users appears to be closely related to evolving patterns of drug use in the region in recent decades. Evidence suggests increase in number of drug users, decrease in the age at first use of drugs and some indication of an increased percentage of women using drugs in several countries.

The United Nations Office of Drugs and Crime (UNODC) estimates there are 400,000 injecting drug users in Arab countries and approximately 200,000 in Iran. These figures do not include a recent increase in numbers in Afghanistan which have been observed.

The sharing of contaminated injecting equipment among injecting drug users has become the predominant route of HIV infection in at least two countries since the mid to late 1990s – Iran and Libya –where a concentrated epidemic now appears to be well established.

“This is a real and growing issue for countries in the Middle East and North Africa. And although we are seeing increasing willingness to introduce HIV prevention and treatment programmes for drug users, focused efforts are needed urgently to ensure access to services for all drug users and their partners,” said Oussama Tawil, Director of UNAIDS’ Regional Support Team, Middle East and North Africa.

Over the last years, UNAIDS and UNODC have supported assessments on drug use and HIV-related risks in Algeria, Egypt, Libya, Morocco, as well as in Oman and Syria, as part of efforts to better understand trends and dynamics of the epidemics in the region and to increase HIV prevention efforts.

Main findings ensued suggest that needle sharing, ranging from 40 to 60%, coupled with low knowledge on AIDS, limited access to health and HIV-related services, stigma and discrimination, and other associated risk factors, are among some of the challenges faced by the region to reduce HIV risks and vulnerability among injecting drug users.

Within the assessments, researchers spoke to drug users about their thoughts and fears: “If I enter [a treatment center] I'll be marked, and my future is over. I will not be able to do anything, neither work nor life," said one of the participant.

“Drug use and other risk behaviors remain stigmatized in the region, which is why we must forge strong partnerships with different sectors, such as the national AIDS programmes, non-governmental organizations, drug users, people living with HIV and law enforcement agencies, to be able to better understand the epidemic and implement concrete solutions,” said Mr Tawil.

Foundations for an increased response to address HIV risks and vulnerability among drug users have been established in some countries and are underway in others. In Iran – considered a global best practice model – HIV-related initiatives for injecting drug users inside and outside prisons are now being scaled up beyond the pilot levels.

In an example of a bold movement to better tackle the issue of HIV and drug use in the region, representatives from law enforcement agencies, national AIDS programmes, NGOs, researchers, community representatives, people living with HIV, UN organizations and other partners will join at a regional workshop to be held in Cairo, Egypt from 5 – 8 November.

The workshop— “Towards Implementation of a Comprehensive HIV response and AIDS Response Among Drug Users in the Middle East and North Africa”— convened by UNAIDS and its cosponsors UNODC and the World Health Organization (WHO) as well as the German Technical Coorperation (GTZ), will welcome participants from 16 countries and aims to build capacities on programming and implementing HIV prevention, treatment and care interventions among drug users.

As part of the workshop, UNAIDS and UNODC will launch the finalized Rapid Situation Assessment on Drug Use and HIV in Algeria and Morocco, as well as facilitate consensus on programmatic follow up for all participating countries. WHO and the International Harm Reduction Association will also launch the project on strengthening the role of civil society in harm reduction for injecting drug users in the Middle East and North Africa.

“This gathering bringing together wide diversity of partners is unique for the region and a turning point for action on drug use and HIV in the region” Mr. Tawil said.