ITU TELECOM WORLD 2009 welcomes Youth Forum participants.
Credit: ITU / F. Rouzioux

Digital and technological revolutions have dramatically changed the way in which people communicate around the world. Many communities in developing countries don’t yet have access to computers and the internet however according to the International Telecommunications Union (ITU) an estimated 2.2 billion mobile phone users lived in developing countries by end 2008 – 64% of the global market. Estimates show that by 2012, half of all individuals in remote areas of the world, who often do not have access to clean running water, electricity or the Internet, will have mobile phones.

H.E. Mr Ban Ki-Moon, UN Secretary-General and Dr Hamadoun Touré Secretary General of the International Telecommunication Union (ITU) observing the vibrant Opening Ceremony of TELECOM 2009
Credit: ITU / F. Rouzioux

The ITU is gathering the global telecommunications sector together in Geneva this week for Telecom WORLD 2009. The United Nations Secretary-General Ban Ki-moon opened the conference on 5 October. Delegates will explore areas of societal change including the digital divide, climate change, and disaster relief. With its focus on development opportunities, the event brings together corporate social responsibility and displays cases of best practices.

The explosion of mobile technology presents a great opportunity to scale up the AIDS response in poor countries.

UNAIDS Executive Director Michel Sidibé is convinced of the value of this approach. “Communication tools are reaching more and more people even in the most remote villages. They connect us all into a global community,” he said.

“Harnessing technology in creative ways will help us reach people in need. I want universal access to HIV prevention, treatment, care and support services to be as ubiquitous as mobile phone coverage,” Mr Sidibé continued.

Through mobile technology, the millions of people in developing countries who had been left behind by the digital divide are now able to access health information and healthcare services at their fingertips. Mobile phones are being used as low-cost tools for HIV testing, data collection, epidemic tracking, and training of health workers, HIV prevention and treatment support.

Some innovative examples include the HIV awareness and testing campaign via SMS (“Text to Change”, Uganda); HIV testing and treatment support with mobile phones (“Project Masiluleke”, South Africa); strengthening health systems via mobile phones (“Phones for Health”, Rwanda); and smart cards to monitor HIV patients (India and Zambia). These are a small part of the growing field of mHealth, whereby mobile communications, such as mobile phones and portable digital assistants (PDAs), are used for health services and information. mHealth programmes are gaining prominence in regions worldwide.

SMS messages can help change behaviour

Short message service (SMS) messages now offer a cost-effective, and efficient method of disseminating health messages in developing countries. According to the UN Foundation report mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World, formal studies and anecdotal evidence demonstrate that SMS alerts have a greater impact in influencing behaviour than radio and television campaigns.

SMS alerts are also relatively unobtrusive, offering the user confidentiality in environments where HIV is often taboo. In developing countries, SMS alerts have proven highly effective in targeting hard-to-reach populations in rural areas, where the absence of clinics, lack of healthcare workers and limited access to health information often prevent people from making informed decisions about their health.

SMS campaigns on HIV testing and treatment support

A growing number of countries, largely in Africa, are partnering with local mobile phone carriers to launch HIV awareness and testing campaigns via SMS. These campaigns have been particularly effective in providing young people with the facts about HIV and encouraging them to get tested. Mobile phones have also been used to encourage people living with HIV to take their medication and go to their medical appointments. Taking HIV medication regularly is crucial to avoiding drug resistance. 

Project Masiluleke uses mobile technology to encourage South Africans to get tested for HIV. It sends one million “Please call me” text messages each day throughout South Africa, encouraging people to get tested and treated for HIV. The SMS messages are written in local languages, and are used to direct users to the National AIDS Helpline. Once patients call, the hotline representatives provide information on HIV testing services and locations. Knowing one’s HIV status is critical in a country where almost 20% of the population is living with HIV, but less than 3% know their status.

Using mobile technology for diagnosis and data collection

Health workers in remote areas with no health facilities are now able to diagnose and provide treatment support to people living with HIV through wireless access to medical information databases or medical staff. As a result, patients are able to receive treatment in their villages and homes.

Furthermore, data collection from remote areas is much faster, reliable and more efficient through mobile technology. Innovative initiatives such as “Phones for Health” are helping to close the information gap that exists for patient data in developing countries, allowing decision-makers to make smarter investments by allocating resources where they are needed most. Data collection is a crucial component of HIV programmes in developing countries as policymakers and health providers at the national, district and community level need accurate data to determine the effectiveness of existing programmes and shape new policies. 

GIS mapping to strengthen HIV programmes

WHO in collaboration with its partners is strengthening HIV surveillance, prevention and treatment programmes in countries by using a global information and mapping system compiled through remote field data collection tools, wireless applications and satellite systems. This allows WHO to monitor and analyze the epidemiological trends in HIV infection worldwide as well as the effectiveness of HIV prevention and treatment programmes. For example, the data collected through the mapping system can help health experts determine which health centres have sufficient stock of antiretrovirals (ARVs).

Web-based technology to fight HIV

In addition to mobile technology, web-based technology is also revolutionizing the way health information is disseminated across the globe. A large proportion of people worldwide are now able to access information about HIV transmission, prevention, care and treatment with the click of a mouse.

When it comes to educating young people about HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its Cosponsors, particularly UNICEF, UNFPA and The World Bank, are using the web in innovative ways to disseminate messages about HIV prevention.

In 1998, UNAIDS and UNICEF partnered with MTV to launch the award-winning Staying Alive campaign. Ten years later, it has become the world’s largest, youth-focused, HIV prevention campaign. UNICEF’s Voices of Youth website offers young people a safe and supportive space where they can explore, discuss and partner on health, development and human rights issues, including ways to stop the spread of HIV. 

Tapping into viral communication trends

Social media networks such as Facebook, MySpace, and Twitter are gaining popularity worldwide. These examples of viral communication encourage greater interactivity whereby information is disseminated more broadly and quickly. This trend is accelerating the pace at which information is communicated, and its potential to reach new audiences with precise and tailored messages is impressive.

Like many organizations, UNAIDS is increasing its use of social media networks to get its messages out to new and existing audiences. UNAIDS has a presence on both Facebook and Twitter and engages with the sites’ users by posting regular updates and encouraging user comments and feedback. Content-sharing sites like Flickr and YouTube also enable UNAIDS to share its audiovisual content to people worldwide.

The aim of using social media networks is simple: to disseminate messages about HIV and encourage young people to take action to stop the spread of HIV.

Looking ahead

As new technologies continue to evolve, so will the way in which countries respond to HIV. By staying on top of emerging technology trends, countries will be able to use innovative tools to provide people, even in the most remote villages, with access to HIV prevention and treatment services.

2008 has been a year of progress, challenge, debate, and change. In this year end review, UNAIDS provides a snapshot of key issues, events, and initiatives that shaped the global AIDS response in the past 12 months.

HIV prevention and treatment efforts lagging behind
	Significant challenges in the AIDS response remain: for every two people put on treatment, five others are newly infected. The total number of people living with HIV has increased to 33 million. Nearly 6 million people are in need of treatment today. Access to pediatric treatment for children is lagging behind, and men who have sex with men, people who inject drugs and sex workers are often ignored by HIV prevention and treatment programmes. WHO/UNAIDS/UNICEF 2008 Universal Access report (pdf, 35 Kb) UNICEF Third Stocktaking Report on Children and AIDS Investing in HIV prevention technologies

Is there a single magic bullet for HIV prevention?
	HIV prevention strategies and programmes have been at the centre of many debates. Various experts have approached it from different angles: the role of multiple sexual partners and concurrent relationships, HIV treatment as prevention, male circumcision, the role of condoms, and delaying sexual debut have been subjects of discussion. UNAIDS has argued that the word “only” doesn’t work for AIDS—whether it is for treatment only, HIV prevention only, condoms only, abstinence only or male circumcision only. In reality all are needed—a truly comprehensive approach. For UNAIDS, the three pillars of a comprehensive and effective AIDS response, as we move towards universal access, are HIV prevention, treatment, and care and support. UNAIDS advocates that countries implement HIV prevention programmes that will be truly effective in reducing new HIV infections. This requires a strategic combination of interventions that address populations that are at risk or vulnerable for HIV transmission and that utilize behavioral and social change methods that are appropriate and informed by the latest evidence. The Lancet special series on prevention UNAIDS’ response to Science article “Reassessing HIV prevention” (pdf, 32 Kb)

Mr Michel Sidibé appointed new UNAIDS Executive Director.
	Michel Sidibe, the current Deputy Executive Director of Programmes for UNAIDS, was appointed the new Executive Director of UNAIDS on World AIDS Day. He assumes his new position in January 2009. Read press release

UNAIDS Deputy Executive Director Michel Sidibé (right) welcomed International Cricket Council President David Morgan to UNAIDS to discuss their continued partnership on AIDS. Geneva, 17 November 2008. Credit: UNAIDS/D. Bregnard

The President of the International Cricket Council (ICC), David Morgan, today visited the UNAIDS Secretariat in Geneva where he was welcomed by UNAIDS Deputy Executive Director Michel Sidibé.

In a meeting with UNAIDS and UNICEF staff the ICC President reaffirmed the Cricket Council’s commitment to the partnership which began in September 2003 when UNAIDS and ICC first teamed up to bring messages of HIV prevention to young people across cricket playing nations. In 2006 UNICEF also joined the partnership which now also supports the “Unite for Children, Unite against AIDS” campaign.

Michel Sidibé reviewed the global successes in the short history of this partnership where through high-profile international events as well as local initiatives, players as well as coaches have spread messages to dispel stigma and misplaced fear and misunderstanding about HIV. He also spoke about the importance of HIV prevention and support services reaching young people.

“We must focus on supporting and working alongside a new generation of young leaders in the AIDS response, including those living with HIV. The work of this partnership can be instrumental in this,” noted Mr Sidibé.

“I would especially like to congratulate the ICC leadership on its commitment to this work and personally thank you for your visit to UNAIDS today.”

A series of Public Service Announcements on HIV have been recorded by leading stars such as Graeme Smith, Kumar Sangakkara and Mahendra Singh Dhoni for use in stadia at ICC Events and by broadcasters. Activities have taken place at international events including the ICC Cricket World Cup and the ICC World Twenty20 2007. This has included leading players visiting local community projects and wearing red ribbons to show their support for people living with HIV.

A “Cricket HIV and AIDS curriculum” has been developed by the ICC and UNAIDS for players and coaches to help inform young people about HIV and how they can use their influence to make a positive change in their communities. Under the programme “The Captain’s Pledge,” Captains of all Test Cricket playing nations took part in a series of initiatives to help young people understand how HIV is transmitted.

Spirit of Cricket

An interactive discussion on strategic planning for the coming years was led by UNICEF Partnerships Manager, Andres Guerrero.

At the meeting, UNAIDS Youth Intern Korey Chisholm spoke of how sport can be a force for change through breaking down age barriers and building self-esteem. He thanked the ICC for replacing stigma with support. UNAIDS Intern Shashank Mane, from India, also shared his thoughts on the partnership:

“Looking at the influence of cricket in my life, I feel that UNAIDS and the ICC have a lot to offer each other, as well as the world, when it comes to connecting young people through sports with AIDS awareness.”

“The influence of cricket is growing around the world; unfortunately, AIDS continues to be transmitted as well. I could not think of a better way to spread HIV prevention messages and to eradicate HIV-related stigma and discrimination than through a partnership such as this one.”

Mohamed Alabbar, Chairman, Emaar Properties and co-chair of the Summit on the Global Agenda, speaking at the Introductory Session of the Summit on the Global Agenda, 07 November - 09 November 2008. Copyright World Economic Forum/Photo by Dana Smillie.

The World Economic Forum's first Summit of the Global Agenda Councils - a unique gathering of leaders from academia, business, government and civil society – is taking place in Dubai, United Arab Emirates from 7 to 9 November. UNAIDS Executive Director Dr. Peter Piot is in Dubai participating in this event.

The Summit aims to advance solutions to the world’s most critical challenges; the Forum’s new Global Agenda Council is being billed as the world’s foremost intelligence and knowledge network.

Over the coming days, Dr. Piot, in his role as Chairman of the Global Agenda Council for HIV/AIDS, will participate in several workshops and sessions where discussions will be held on how to improve the state of the world, highlighting specific issues including HIV, systemic financial risk, global governance, energy security, child welfare, climate change and food security. Further issues under discussion will be actions and actors in these areas; presentation of key insights from the Councils discussions; and decisions on next steps for the Councils.

The outcomes of this Summit will be presented for further discussion and action at the World Economic Forum’s upcoming Annual Meeting 2009 in Davos, Switzerland.

The Clinton Global Initiative (CGI) is a
non-partisan catalyst for action that brings
together a community of global leaders
from various backgrounds to devise and
implement innovative solutions to some
of the world’s most pressing challenges.

The annual meeting of the Clinton Global Initiative (CGI) concludes today in New York. The three-day event brought together a diverse group of world leaders from government, business, international agencies and civil society to examine global challenges and transform that awareness into action.

UNAIDS Executive Director Dr Peter Piot and former President of the Portuguese Republic, Jorge Sampaio participated in a working group breakfast on global health which addressed AIDS, tuberculosis, and malaria.

Increased effort and investment in the AIDS response in recent years have yielded examples of successful approaches that can be replicated or scaled up globally. The participants identified and explored opportunities to improve the way we respond to these diseases with existing tools and knowledge and highlighted current challenges.

Since its inception in 2005, CGI has convened a community that includes more than 80 current and former heads of state, hundreds of business, international and non-profit leaders, major philanthropists, and Nobel Peace Laureates. Their aim is to devise and implement innovative solutions to some of the world’s most pressing challenges.

The 2008 Annual Meeting focussed on challenges and opportunities in the following four focus areas: education, energy and climate change, global health and poverty alleviation.

The International Task Team on HIV-related Travel Restrictions concluded its third meeting with draft recommendations towards the elimination of HIV-specific restrictions on entry, stay and residence. In the coming months, these will be finalized and presented to the boards of the Global Fund and UNAIDS this November and December.

Restricting entry, stay or residence in a country due to HIV positive status alone is discriminatory, and in today’s highly mobile world, such restrictions have even greater impact on people living with HIV. In 2008, some 67 countries continue to have such restrictions.

In early 2008, UNAIDS set up an international task team of governments, civil society groups and international organizations to bring the issue of HIV-related travel restrictions back onto the agenda and promote action towards their elimination. Co-chaired by UNAIDS and the Government of Norway, the Task Team met for the first time in Geneva in February 2008, followed by a second meeting at the Office of the UN High Commissioner for Human Rights in Geneva in April, and the third and final meeting in Madrid at the headquarters of the World Tourism Organization (UNWTO).

At the third meeting, the Task Team took
stock of all the advocacy and activities
conducted by Task Team members against
travel restrictions and noted that there
indeed is much greater momentum toward
their elimination. Credit: UNAIDS

The third meeting, which took place from 24-26 June, was opened by Francisco Elías de Tejada Lozano, former Spanish Ambassador to the Global Fund, Spanish Ministry of Foreign Affairs, and Francesco Frangialli, Secretary-General of UNWTO. Frangialli underlined that travel restrictions based on HIV status are discriminatory, and are a major concern to the entire tourism sector.

“HIV is not something that transmits through the air. If there are going to be restrictions, they have to be rational and reflect legitimate public health concerns. For HIV, what’s needed is prevention information and dialogue,” said Frangialli.

At the third meeting, the Task Team took stock of all the advocacy and activities conducted by Task Team members against travel restrictions and noted that there indeed is much greater momentum toward their elimination.

For example, civil society groups conducted significant advocacy leading up to the High-Level Meeting on AIDS at the UN General Assembly in June. At that meeting, both UN Secretary-General Ban Ki-Moon and UNAIDS Executive Director Peter Piot called for the end of HIV-related travel restrictions in their speeches at the opening session of the General Assembly. “Stigma and discrimination around AIDS remain as strong as ever: and in this context I join my voice with the Secretary General and I call on all countries to drop restrictions on entry to people simply because they are living with HIV,” said Dr Piot.

Task Team members also underlined during the third meeting that ongoing awareness-raising is needed, and that the Task Team’s work has to be followed by intense country-level action that leads to the elimination of travel restrictions.

“At this point in the epidemic, with over 25 years of experience, it’s hypocrisy if there’s no change and governments say that they’re committed to ending stigma and discrimination,” said Craig McClure, Executive Director of the International AIDS Society.

Susan Timberlake, Task Team Co-chair and Senior Human Rights and Law Adviser at UNAIDS, stated that more effort is needed to ensure that tourists, migrants and other mobile populations are addressed in national AIDS responses.

“Countries need to understand that any HIV vulnerability related to mobility is not just about tourists and migrants, it is also about nationals, entering, departing and re-entering. If governments really want to reduce HIV vulnerability related to mobility they should ensure that all mobile people benefit from appropriate HIV programmes and services. In the era of Universal Access and increasing globalization, no comprehensive AIDS response should leave out people on the move,” she said.

Restrictions on the entry, stay and residence of people living with HIV will be highlighted during a Special Session at the International AIDS Conference in Mexico this August, as well as the Global Forum on Migration and Development in the Philippines in October. The final recommendations of the Task Team will be presented in a report at the next meeting of UNAIDS Programme Coordinating Board in December 2008 and to the board of the Global Fund of Fight AIDS, TB and Malaria in November.

The AIDS epidemic and the climate change phenomenon are two of the most important “long wave” global issues of the recent past, present and future. They share similarities, interactions, and present possibilities for a more united response. Yet, these links have received little analysis so far.

For that reason, several UN agencies, research institutes from Switzerland, India, South Africa and Canada as well as the International Federation of Red Cross and Red Crescent Societies gathered to analyse the existing links between AIDS and climate change in a technical meeting held in Nyon, Switzerland, on 20 May 2008.

Furthermore, a joint position paper on AIDS and climate change was commissioned by UNEP and UNAIDS from the Australian National University in February 2008. This paper, whose findings where also discussed at the Nyon meeting, focuses on scientific issues, identifying major, minor, and speculative pathways by which HIV and climate change are likely to interact.

The faith community makes a major
contribution to the worldwide response to
AIDS, especially in poorer developing
countries, where faith-related facilities may
be the sole source of health assistance.

Seventy percent of the world’s population identify themselves as members of a faith community, which situates communities of faith in a privileged position to influence people’s behaviour and attitudes, even in relationship with the AIDS epidemic.

Organizations motivated by religious faith - often called Faith-based organizations (FBOs) - have been involved in the AIDS response since the earliest days of the epidemic and have often been among the first to respond, providing services, education and care.

UNAIDS in collaboration with UNFPA, WHO, ILO and UNDP will bring together a working group of partnership officers from across the UNAIDS Secretariat and Cosponsor organizations and FBO representatives to outline a strategy for future work with faith-based organizations on AIDS issues.  The meeting, which will take place from 9 – 11 April in Geneva, will aim to establish a strategy for a more coordinated response to partnership work among all stakeholders involved in the AIDS response.

Religious communities, mosques, temples, churches, hospitals and clinics have reached out to provide support to those living with and affected by HIV. Many have been involved in the response since the earliest days of the epidemic. Their leadership has great influence in the lives of many people, and leaders speaking out responsibly about AIDS can make a powerful impact at both community and international level.

Participants will analyse how to best work
with the wide range of FBOs working on
AIDS, discussing the opportunities and
challenges that they offer.

However the response of the religious community can also be negative. People living with HIV have been stigmatized by religious leaders and communities of faith. Approaches to HIV prevention methods and attitudes towards people at increased risk of HIV infection such as men who have sex with men, have sometimes hindered the response. Much work remains to be done to eradicate stigma and discrimination.

The faith community makes a major contribution to the worldwide response to AIDS, especially in poorer developing countries, where faith-related facilities may (in some areas) be the sole source of health assistance.  The ARHAP/WHO report (2007) found that faith-related organizations were providing 33 to 40 percent of all HIV health care and treatment services in Zambia and Lesotho, and calculated that between 30 and 70 percent of all healthcare infrastructure across the continent is operated by faith-based groups.

Furthermore, it is clear that faith communities are ideally placed to respond in the broadest way to the epidemic’s challenges, not just as providers of services but also (and perhaps most importantly) as networks and movements that reach right to the heart of community and family life.  This makes them key players in a holistic, multifaceted, integrated response to AIDS.  It is for this reason that UNAIDS is currently exploring a deeper engagement with ‘faith-based organizations’.

Participants at this meeting will analyse how to best work with the wide range of FBOs working on AIDS, discussing the opportunities and challenges that they offer. The working group will produce a three to five years strategy that will guide the UNAIDS and its cosponsors efforts to consolidate a coordinated response to AIDS with the faith community.

(from left, front):  Michel Kazatchkine, Executive Director, Global Fund; Margaret Chan, Director General, WHO); Peter Piot, Executive Director, UNAIDS; Jorge Sampaio, UN Secretary General’s Special Envoy to Stop TB and former president of Portugal and (from left, back): Jorge Bermudez, Executive Secretary of UNITAID; Mario Raviglione, Director WHO Stop TB Department; Marcos Espinal, Executive Secretary of the Stop TB Partnership at the launch of Global Tuberculosis Control 2008 report. Geneva, 17 March 2008.
Credit: WHO/C. Black

Almost quarter of a million people living with HIV died from tuberculosis (TB) in 2006 according to a new report published by the World Health Organization (WHO).

The annual report, Global Tuberculosis Control 2008, also shows that nearly 3/4 million people living with HIV fell ill with TB disease in 2006, confirming that TB is a major cause of illness and death in people living with HIV despite being mostly preventable and curable. Africa is yet again the most heavily affected continent, with 85% of the global burden of HIV-related TB. 

The report also contained good news, with encouraging signs, especially from Africa, that TB and HIV programmes are increasingly working together to reduce the heavy burden of TB in people living with HIV. For example in Rwanda the TB programme were able to provide HIV testing to 76% of all TB patients, thus making sure that they were able to access the best HIV prevention, treatment and care services.  Much more work is needed, however, to make sure that people living with HIV have better access to TB prevention, diagnosis and treatment services, e.g. less than 1% of people living with HIV were screened for TB in 2006.

Dr Peter Piot, Executive Director, UNAIDS addressed the press launch of Global Tuberculosis Control 2008. Geneva, 17 March 2008.
Credit: WHO/C. Black

"The report tells us that we are far from providing universal access to high-quality prevention, diagnostic, treatment and care services for HIV and TB," said Dr Peter Piot, Executive Director of UNAIDS.

"Clear progress has been made but we must all do more to make a joint approach to reducing TB deaths among people with HIV a reality."

The report was launched in Geneva by Peter Piot (Executive Director, UNAIDS), Margaret Chan (Director General, WHO), Michel Kazatchkine (Executive Director, Global Fund) and Jorge Sampaio (UN Secretary General’s Special Envoy to Stop TB and former president of Portugal) in time for World TB Day (24 March).

UNAIDS, WHO, the Global Fund, the Stop TB Partnership along with our national and international partners, will be working closely together to ensure universal access to integrated HIV and TB services and ensure a coordinated response to the epidemics of HIV and TB – this is the only way forward if we are to produce a truly effective response.

Since the beginning of the HIV epidemic, governments and the private sector have implemented travel restrictions with regard to HIV positive people wishing to enter or remain in a country for a short stay (e.g. business, personal visits, tourism) or for longer periods (e.g. asylum, employment, immigration, refugee resettlement, or study).

The international task team on HIV-relate
travel restrictions met for the first time in
Geneva on 25-26 February. The meeting
was co-chaired by UNAIDS and the
Government of Norway.

UNAIDS has set up an international task team to heighten attention to the issue of HIV-related travel restrictions (both short-term and long-term) on international and national agendas and move towards their elimination.

The international task team met for the first time in Geneva on 25-26 February. The meeting, co-chaired by UNAIDS and the Government of Norway, brought together representatives of governments, inter-governmental organizations and civil society, including the private sector and networks of people living with HIV.

According to data collected by the European AIDS Treatment Group, a total of 74 countries have some form of HIV-specific travel restrictions, 12 of which ban HIV positive people from entering for any reason or length of time. The most common reasons used are to protect public health and to avoid possible costs associated with care, support and treatment of people living with HIV.

Whatever the reason, HIV-related travel restrictions raise fundamental issues regarding the human rights of non-discrimination and freedom of movement of people living with HIV in today’s highly mobile world.

In the year 2000, the World Tourist Organization estimated that there were 698 million international arrivals world-wide. The majority of these people are travelling for short periods of time, e.g. for tourism, business, conferences, family visits. With regard to longer-term mobility, the International Organization for Migration (IOM) estimates that some 175 million migrants currently live and work outside their country of citizenship, i.e., 2.9 per cent of the world’s population.

HIV -related travel restrictions usually take the form of a law or administrative instruction that requires people to indicate their HIV-free status before entering or remaining in a country. Some countries require people to undergo an HIV test whereas others require an HIV-free certificate or simply that people declare their HIV status.

Testing under such circumstances is akin to mandatory testing, and in many instances is done without appropriate pre and post-test counselling or safeguards of confidentiality. Any HIV testing should be done voluntarily and on the basis of informed consent.

The personal impact of HIV-related travel restrictions can be devastating for the individual seeking to immigrate, to gain asylum, to visit family, to attend meetings, to study, or to do business. The candidate immigrant, refugee, student or other traveller may simultaneously learn that s/he is infected with HIV, that s/he may not be allowed to travel, and possibly that his/her status has become known to government officials, or to family, community, and employer, exposing the individual to possibly serious discrimination and stigma.

For those already in a receiving country, they may face summary deportation without due process of law and protection of confidentiality. Under such circumstances, there is every incentive to hide or deny one’s HIV status and to avoid contact with immigration authorities and health care workers. Both immigration controls and public health efforts are thereby undermined, while individuals are cut off from prevention, assistance and, perhaps, needed health services.

“Travel restrictions based on HIV status
again highlight the exceptionality of AIDS,
especially short-term restrictions," said
UNAIDS Executive Director Dr Peter Piot.

“Travel restrictions based on HIV status again highlight the exceptionality of AIDS, especially short-term restrictions," said UNAIDS Executive Director Dr Peter Piot. "No other condition prevents people from entering countries for business, tourism, or to attend meetings. No other condition has people afraid of having their baggage searched for medication at the border, with the result that they are denied entry or worse, detained and then deported back to their country", he added.

While recognizing that control of a country’s borders and matters of immigration fall under the sovereign power of individual States, national laws and regulations should ensure that people living with HIV are not discriminated against in their ability to participate equally in international travel, in seeking entry or stay in a country that is not their own. The International Guidelines on HIV/AIDS and Human Rights state that any restriction on liberty of movement or choice of residence based on suspected or real HIV status alone, including HIV screening of international travellers, is discriminatory.

Besides being discriminatory, travel restrictions have no public health justification. HIV should not be considered to be a condition that poses a threat to public health in relation to travel because, although it is infectious, the human immunodeficiency virus cannot be transmitted by the mere presence of a person with HIV in a country or by casual contact.

Restrictive measures can in fact run counter to public health interests, since exclusion of HIV-positive non-nationals adds to the climate of stigma and discrimination against people living with HIV, and may thus deter nationals and non-nationals alike from coming forward to utilize HIV prevention and care services. Moreover, travel restrictions may encourage nationals to consider HIV a “foreign problem” that has been dealt with by keeping foreigners outside their borders, so that they feel no need to engage in safe behaviour themselves.

Travel restrictions do not have an economic justification either. People living with HIV can now lead long and productive working lives, a fact that modifies the economic argument underlying blanket restrictions: concern about migrants’ drain on health resources must be weighed with their potential contribution. Furthermore, the continued expansion of treatment programmes towards Universal Access by 2010, and the sustained fall in the cost of treatment in low- and middle-income countries dispels the myth that the travel of a HIV positive person would drive up the cost of health care systems abroad.

The creation of an International Task Team on HIV-related Travel Restrictions is a critical opportunity to heighten attention to the issue of HIV-related travel restrictions on international and national agendas and move toward their elimination.

Developing Specific Recommendations for Positive Change

The Task Team will generate concrete
recommendations on specific actions that
different stakeholders can take to move
towards the elimination of HIV-related
travel restrictions.

The International Task Team comprises two working groups which focus on short-term and long-term restrictions, supported and guided by a Steering Committee. The Working Groups and the Steering Committee of the Task Team will meet four times before August 2008, when its final recommendations will be presented at the International AIDS Conference in Mexico. The Task Team will generate concrete recommendations on specific actions that different stakeholders (government, civil society, intergovernmental organizations and the private sector) can take to move towards the elimination of HIV-related travel restrictions. The Task Team will focus on key strategic actions that:

1. Increase attention to the issue of HIV travel restrictions internationally, regionally and nationally
2. Influence governments that have HIV-related travel restrictions relating to entry and short-term stay to remove such restrictions; and
3. Spur longer term action to move towards the elimination of all HIV-specific travel restrictions.

In developing these recommendations, the Steering Committee will be supported by the Working Groups which will be requested to undertake:

1. A critical mapping of the current situation related to the use of short-term and long-term HIV-related travel restrictions
2. An analysis of the obstacles to eliminating the different types of HIV-related travel restrictions and possible actions by various national and international stakeholders to support this elimination, and
3. Recommendations on best practice regarding the entry and stay of people living with HIV in different contexts of mobility and migration.

Recommendations will support the principles of non-discrimination and the Greater Involvement of People Living with HIV and rational HIV-related policies for travellers, migrants and mobile populations in sending and receiving countries – in the context of efforts to achieve universal access to HIV prevention, treatment, care and support, as agreed by governments at the High Level Meeting on AIDS (2006).

The International Task Team on HIV-related Travel Restrictions will hold its next meeting on 31st March – 2nd April in Geneva.