Renewed commitment needed in Eastern Europe and Central Asia, the Middle East and North Africa and for key populations.

GENEVA, 20 November 2013—Accelerated progress has been reported in most parts of the world. However, there are worrying signs that some regions and countries are not on track to meet global targets and commitments on HIV.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) reports that new HIV infections have been on the rise in Eastern Europe and Central Asia by 13% since 2006. The Middle East and North Africa has seen a doubling of new HIV infections since 2001.

In many cases stalled progress is due to inadequate access to essential HIV services. Key populations including men who have sex with men, people who use drugs, transgender people and sex workers are often blocked from accessing life-saving services.

“Every person counts,” said Michel Sidibé, Executive Director of UNAIDS. “If we are going to keep our pledge of leaving no one behind—we have to make sure HIV services reach everyone in need.”

Investments focused on reaching key populations have not kept pace. Funding for HIV prevention services for men who have sex with men is especially limited in East Asia, the Middle East and North Africa, and across sub-Saharan Africa. Investments lag in a number of countries where HIV prevalence among people who inject drugs is high. Ten countries in which HIV prevalence among people who inject drugs exceeds 10%, allocate less than 5% of HIV spending to harm reduction programmes. Notwithstanding sex workers’ disproportionate risk of acquiring HIV, prevention programmes for sex workers account for a meagre share of HIV prevention funding globally.

While much work needs to be done in Eastern Europe, for the first time in 2012, Ukraine has reported a decline in the number of newly identified HIV cases, representing a new turning point for the country. There are an estimated 200 000 people living with HIV in Ukraine. At 21.5%, HIV prevalence is highest among people who inject drugs.

However, by working together, the Ukrainian government and civil society organizations are striving to provide essential HIV services to support key populations, using evidence to guide investments and programmes. In 2011, Ukraine also amended its AIDS law which now guarantees harm reduction services for people who inject drugs, confidentiality of HIV status for people living with HIV and removal of HIV-related travel restrictions.

More attention needed for children and adults aged 50 and over

In priority countries, only three in 10 children receive HIV treatment under 2010 WHO treatment guidelines. Children living with HIV continue to experience persistent treatment gaps. In 2012, 647 000 children under 15 years of age were receiving antiretroviral treatment. HIV treatment coverage for children (34% (31-39%)) remained half of coverage for adults 64% (61-69%)) in 2012 under the old guidelines.

“We have seen tremendous political commitment and results to reduce mother-to-child transmission of HIV—but we are failing the children who become infected,” added Mr Sidibé. “We urgently need better diagnostic tools and child-friendly medicines—irrespective of the market size.”

Although the number of children receiving antiretroviral therapy in 2012 increased by 14% in comparison to 2011, the pace of scale-up was substantially slower than for adults (a 21% increase). The failure to expand access in many settings to early infant diagnosis is an important reason explaining why HIV treatment coverage remains much lower for children than for adults. In three priority countries, Chad, Democratic Republic of the Congo and Malawi, coverage of less than 5% was reported for early infant diagnostic services in 2012.

An increasingly significant trend in the global HIV epidemic is the growing number of people aged 50 years and older, who are living with HIV. Worldwide, an estimated 3.6 [3.2–3.9] million people aged 50 years and older are living with HIV. This “aging” of the HIV epidemic is mainly due to three factors: the success of antiretroviral therapy in prolonging the lives of people living with HIV; decreasing HIV incidence among younger adults shifting the disease burden to older ages; and the often-unmeasured, and thus often overlooked, fact that people aged 50 years and older exhibit many of the risk behaviours also found among younger people.

Global AIDS data

New HIV infections among adults and children were estimated at 2.3 million in 2012, a 33% reduction since 2001. New HIV infections among children have been reduced to 260 000 in 2012, a reduction of 52% since 2001. AIDS-related deaths have also dropped by 30% since the peak in 2005 as access to antiretroviral treatment expands.

By the end of 2012, some 9.7 million people in low- and middle-income countries were accessing antiretroviral therapy, an increase of nearly 20% in just one year. In 2011, UN Member States agreed to a 2015 target of reaching 15 million people with HIV treatment. However, as countries scaled up their treatment coverage and as new evidence emerged showing the HIV prevention benefits of antiretroviral therapy, the World Health Organization set new HIV treatment guidelines, expanding the total number of people estimated to be in need of treatment by more than 10 million.

Significant results have also been achieved towards meeting the needs of tuberculosis (TB) patients living with HIV, as TB-related deaths among people living with HIV have declined by 36% since 2004.

Despite a flattening in donor funding for HIV, which has remained around the same as 2008 levels, domestic spending on HIV has increased, accounting for 53% of global HIV resources in 2012. The total global resources available for HIV in 2012 was estimated at US$ 18.9 billion, US$ 3-5 billion short of the US$ 22-24 billion estimated to be needed annually by 2015.

Chinese and African leaders during the first day of the 4th International Roundtable on China-Africa Health Cooperation. 6 May 2013

Leaders from China and Africa met in Gabarone, Botswana this week for the 4^th International Roundtable on China-Africa Health Cooperation in order to strengthen collaboration in health development and share knowledge and technology. The two day roundtable from 6-7 May was the first to be held in Africa.

Participants committed to develop concrete action plans to address pressing health issues including HIV, malaria, reproductive health, human resources and access to vaccines and commodities. The forum provided an opportunity for open dialogue about lessons learned as well as exploring South-South cooperation initiatives to overcome challenges such as guaranteeing safe products, ensuring adequate capacity, increasing transparency and strengthening health systems. 

“China and Africa have a long history of collaborating on health, built on shared challenges and experiences addressing similar issues,” said Hon. Rev. Dr. John G. N. Seakgosing, Botswana Minister of Health.  “China has a unique role in supporting African health progress. And with this roundtable, we look forward to deepening our partnership to benefit the health of our citizens.”

South-South cooperation, where mutually beneficial partnerships between developing and emerging economies are adding new thinking and new resources to global health and development was a keynote of the roundtable. Such cooperation, creating a ‘win-win’ scenario, is based on shared experience of similar challenges and priorities: both Africa and China view healthcare as critical to their economic success. 

“Africa’s future is closely linked with our own and improving health is a critical building block toward a common prosperity,” said Dr Ren Minghui, Director General of the Department of International Cooperation at China’s National Health and Family Planning Commission. “African countries have made tremendous gains to improve the health of their citizens. With China and Africa working hand-in-hand on health, we can have even greater impact.” 

The forum examined ways in which China can share its advances in research and development, its commitment to producing high-quality, lower cost, safe health technologies and how it can forge new partnerships with African countries. In return China can learn from the continent’s best practices, including progress made in expanding AIDS treatment, responding to the epidemic in rural areas and stopping new HIV infections among children.

H.E. Dr Mustapha Sidiki Kaloko, Commissioner of Social Affairs of the African Union (left) and Dr Luiz Loures, UNAIDS Deputy Executive Director, Programme at 4th China-Africa Roundtable on Health, 7 May 2013

This exchange was analysed in detail during an HIV session, chaired by UNAIDS, which incorporated an update on the ground-breaking African Union roadmap on shared responsibility and global solidarity for AIDS, TB and malaria. Opportunities for strengthened China-Africa HIV partnership were explored, such as developing antiretroviral therapy drug manufacturing technology through joint ventures and technical support for local production.

“The global health landscape is changing with more partners than ever joining these efforts,” said Dr Luiz Loures, UNAIDS Deputy Executive Director, Programme. “The AIDS response and other experiences paved the way for transformative progress on health and can help China and Africa to engage on a whole new level and innovate on a broad range of health issues.”

In addition, the roundtable discussed pilot project proposals for collaboration in areas such as strengthening laboratory systems; training African health personnel and sharing China’s expertise in cold chain management and surveillance systems to boost immunizations.

It is hoped that the roundtable policy consultations will help to lay the groundwork for a long-term strategic collaboration plan around the upcoming Health Ministerial Meeting of the Forum on China-Africa Cooperation in August. 

The 4th China-Africa Roundtable on Health Cooperation was hosted by the Botswana Ministry of Health, Peking University’s Institute for Global Health and China’s Chamber of Commerce and Ministry of Commerce. Joining African and Chinese Minsters of Health, Commerce and Foreign Affairs and their representatives were leaders of the African Union, the United Nations, international organizations, NGOs and major companies.

Parliamentarians from across Asia and the Pacific are urging sustained action on AIDS to ensure an AIDS-free generation in the region. The call came at a Forum held in Bali, Indonesia (25-26 March) where parliamentarians and civil society leaders from 35 countries in Asia-Pacific gathered to assess the progress made and the challenges remaining to achieve the Millennium Development Goals (MDG) in the region.

“We are just starting to see significant results in achieving the MDGs. We cannot abandon them; we must take the MDG agenda forward,” said Hon P Kamalanathan P Pancanathan, Member of Parliament from Malaysia. “We have seen important health, human rights and development gains through the AIDS response that can strengthen other work in global health and sustainable development,” he added.

Calls for a future based on human rights, equality and sustainability resonated throughout the Forum. Rapid increase of access to antiretroviral treatment, the meaningful engagement of communities in the design and roll out of programmes and the removal of laws, policies and practices that hamper access to HIV services for people living with HIV and key populations at higher risk were cited as critical priorities to ensure success in the response to AIDS.

“With political commitment, community mobilization, adequate funding and evidence-based approaches, the end of AIDS and the emergence of an AIDS-free generation can be a shared triumph of the post-2015 era,” said United Nations Secretary-General’s Special Envoy on AIDS in Asia and the Pacific, Prasada Rao.

Effective spending and shared responsibility were linked to results across health and development goals. “We have to ensure smart spending – making sure funds are focused where they are most needed and where they produce most efficiency – which in the Asia Pacific region means focusing on key populations at highest risk of HIV,” said Steven J Kraus, Director of UNAIDS Asia and the Pacific Regional Office at the Forum. “As representatives of the people—including and especially the most vulnerable—parliamentarians have a key role to play in giving voice to the voiceless,” he added.

The parliamentarian and civil society Forum took place alongside, and fed into, the fourth meeting of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, hosted by the President of Indonesia as Panel co-chair. As part of the Forum, a selected delegation of 20 senior parliamentarians and local elected representatives shared with the UN Secretary-General’s High-Level Panel their recommendations about key priorities identified for consideration in the crafting of the post-2015 development agenda.

The Parliamentarians and Civil Society Forum was hosted by the Indonesian Parliament, Indonesian Forum of Parliamentarians on Population and Development (IFPPD), and UNORCID, and co-organized by United Nations Millennium Campaign and the Asian Forum of Parliamentarians on Population and Development (AFPPD) with support from the Rockefeller Foundation, and in collaboration with UNAIDS and a number of other UN agencies, global civil society networks, international nongovernmental organizations, and parliamentary networks.

UNAIDS Deputy Executive Director (Programme) Luiz Loures (left) and Ksenia Yudaeva, G20 Sherpa, Office of the President of the Russian Federation.

In her first visit to Geneva as Russian G20 Sherpa, Ksenia Yudaeva visited UNAIDS Headquarters for a broad ranging discussion on global issues that are priorities for the Russian Presidency of the G20, including civil society participation, youth empowerment and development for all.

“Russia is using its Presidency of the G20 to strategically connect the dots on issues critical to the future of global governance,” said Ms Yudaeva, Chief of the Presidential Experts Directorate and the Russian G20 Sherpa. “UNAIDS’ experience is of special interest to Russia in how to promote civil society participation, transparency and accountability.”

Ms Yudaeva and her delegation from the Russian Sherpa’s Office were welcomed to UNAIDS by Dr. Luiz Loures, UNAIDS Deputy Executive Director (Programme). “UNAIDS welcomes Russia’s unprecedented leadership on global governance. As President of the G20 in 2013 and of the G8 in 2014, Russia has an unprecedented opportunity to leverage support of civil society and young people to advance its priorities of sustainable, inclusive and balanced growth and development for all.”

In 2013 UK will meet its target to spend 0.7% of its national income on international development

GENEVA, 21 March 2013—The Joint United Nations Programme on HIV/AIDS (UNAIDS) welcomes the announcement made by the Rt Hon George Osborne, MP, Chancellor of the Exchequer, that the United Kingdom will meet its target of spending 0.7% of gross domestic product on international development this year.

“The UK is once again demonstrating its steadfast leadership,” said Michel Sidibé, Executive Director of UNAIDS. “Even in times of global economic difficulty it shows they have the interests of the world’s poorest and most vulnerable people at the forefront and UNAIDS looks forward to continuing our close collaboration.” 

The UK is an integral partner in the response to HIV and has made the UNAIDS vision of getting to zero a priority. The UK has shown particular commitment to focused investments in Africa to reduce new HIV infections, stop HIV infections in children, address TB––the leading cause of death among people living with HIV, strengthen human rights, tackle stigma and invest in scientific research.

The UK will be the first member of the G8 to meet the target of 0.7% of gross domestic product which was pledged by United Nations Member States more than 40 years ago in a 1970 UN General Assembly Resolution. This makes the UK the sixth country to meet or exceed the 0.7% target joining only Denmark, Luxembourg, the Netherlands, Norway and Sweden.

The Prime Minister of the UK, David Cameron, serves as co-chair to the United Nations Secretary-General’s high-level panel of eminent persons on the post-2015 development agenda.

The countries of the South are shifting the global power balance with massive strides in economic growth, poverty reduction, education and health.

The world is changing rapidly with developing nations spearheading global economic growth, impressive poverty reduction and the rise of a healthier, better educated middle class, says the UN Development Programme’s (UNDP) Human Development Report 2013.

According to the publication, The Rise of the South: Human Progress in a Diverse World, this rise is “unprecedented in its speed and scale. Never in history have the living conditions and prospects of so many people changed so dramatically and so fast.” 

The momentum of such achievements in poverty reduction, education, income and tackling health issues like HIV, is increasing. It can be seen as an overdue “global rebalancing” with new actors “shaping the development landscape” and gaining in political and economic influence.  

There has been notably rapid progress in more than 40 countries of the South—traditionally referred to as developing nations—whose advancement has been markedly better than expected, the report notes. Coming from all continents and ranging widely in size, they include:  Bangladesh, Brazil, Chile, China, Ghana, India, Mexico, Rwanda, Uganda and Vietnam.  Uganda, for example, through a series of economic, health, education and social measures, has managed to halve extreme poverty before the Millennium Development Goal deadline of 2015. It fell from 56% in 1992-93 to 25% in 2009-10.

The report was launched in Mexico City on March 14 by the UNDP’s Administrator Helen Clark and Mexican President Enrique Peña Nieto.  As well as an extensive analysis of original research, it also contains an updated Human Development Index which measures the progress of nations in terms of health, education and income. In addition, the publication contains data on the critical gender aspect of development in its Gender Inequality Index which shows that despite serious inequities persisting, there has been progress in equality almost everywhere.

As with general development, the pace of success in the AIDS response is quickening in an unprecedented way. The 2012 UNAIDS global report showed that the rate of infection across 25 low- and middle-income countries has been cut by half.

The accelerated development of the South is critical to the success of the global AIDS response as the most heavily burdened countries are low-and middle income. UNAIDS maintains that getting to zero new infections, zero discrimination and zero AIDS-related deaths will need advances not only in the sphere of health and HIV but in terms of poverty reduction, education, gender equality and enhanced life opportunities

How do we promote meaningful empowerment so people everywhere can achieve poverty eradication, social integration, full employment and decent work? This was the key theme of a UNAIDS statement delivered to the 51^st session of the Commission for Social Development in New York on 12 February.

Echoing the priority theme of the entire session, the UNAIDS statement on empowerment highlighted the fact that HIV should be viewed through the prism of a wider development agenda. Citing the seminal 1995 Copenhagen Declaration of the World Summit on Social Development, the statement argued that communicable diseases hinder social progress and often cause poverty and exclusion.

According to the statement, a people-centred approach to the AIDS response will lead to more effective poverty eradication, better social integration and a greater likelihood of having a fulfilling work life. Despite the progress made in this direction to date, the statement also contended that stigma and discrimination are still major barriers to people’s empowerment and that in many countries and communities the human rights of the people living with and affected by HIV are often neglected or flouted.   

UNAIDS called on the gathering to challenge stigma and discrimination in all its forms and promote and protect human rights. This was seen as an imperative not only for an effective challenge to the epidemic but also to achieve sustainable development, social integration and inclusion. 

The 51^st session of the Commission for Social Development is taking place from 6-15 of February and is organised by the Division for Social Policy Development, part of the UN Secretariat’s Department of Economic and Social Affairs.