The United Nations Conference on Sustainable Development, also known as Rio+20 will take place in Rio de Janeiro, Brazil from 20-22 June. The high-level meeting brings together more than 100 Heads of State and government, along with UN officials and representatives of the private sector and civil society to shape new policies to promote prosperity, reduce poverty and advance social equity and environmental protection.

This year’s event marks the 20^th anniversary of the historic 1992 United Nations Conference on Environment and Development (UNCED) that was held in the same city and the 10th anniversary of the 2002 World Summit on Sustainable Development (WSSD) in Johannesburg. The conference is organized by the United Nations Department of Economic and Social Affairs.

“Rio+20 is about building a future we want, it’s about shared aspirations,” said United Nations Secretary-General Ban Ki-Moon speaking ahead of the conference. Rio+20 is a “once-in-a-generation opportunity to make real progress,” he added.

The Conference will focus on two themes: a green economy in the context of sustainable development and poverty eradication; and the institutional framework for sustainable development. It will also focus on seven priority areas: decent jobs, energy, sustainable cities, food security and sustainable agriculture, water, oceans and disaster readiness.

Ahead of the conference, Member States announced that they have reached an agreement on the outcome document of the Conference. “We now have a text which will be adopted at the Conference,” said Rio+20’s Secretary-General, Sha Zukang . “We think the text contains a lot of action, and if this action is implemented, and if follow-up measures are taken, it will indeed make a tremendous difference in generating positive global change.”

Sustainable Development and AIDS

The Rio+20 outcome document states Member States’ commitment to redoubling efforts to achieve universal access to HIV prevention, treatment, care and support, and to eliminate mother-to-child transmission of HIV.

“The global AIDS response has served as a pathfinder and an entry point for inclusive growth, social justice and the restoration of human dignity,” said UNAIDS Executive Director Michel Sidibé. “The AIDS movement demonstrates that through strategic partnerships, even complex and enduring barriers to development can be effectively surmounted,” he added.

According to UNAIDS, there can be no sustainable development without health, human rights and gender equality.

The new book No Time to Lose by Peter Piot, the Director of the London School of Hygiene & Tropical Medicine, is garnering praise as a candid and passionate account of a lifetime pursuing and outsmarting deadly viruses.

Author Dr Piot, the former Executive Director of UNAIDS was a co-discoverer of the Ebola virus and a pioneer of the AIDS response.

“In a world where true discovery is rare, Peter’s experiences are beyond remarkable,” said Michel Sidibé, Executive Director of UNAIDS. “And it is from this special vantage point that he takes us on a personal journey—that is equal part adventure thriller and political primer.”

Early in Dr Piot’s career, many tried to dissuade him from entering the field of infectious diseases. The people who did mentor him were often quirky and highly independent—and they set a tone of nurturing curiosity, questioning and not settling—that would serve the young doctor well.

Not yet 30, he vividly recalls a game-changing event in his life, “The unravelling of the first known epidemic of Ebola haemorrhagic fever in Africa was my initiation into scientific discovery, even life-threatening adventure, and into the world of what is now called global health. The AIDS epidemic forced me to confront the extreme complexity of health and disease and to learn the hard way the realities of big and small politics.”

His first international assignment took him to Zaire (now Democratic Republic of Congo) to investigate the deadly outbreak. Dr Piot became known for combining community wisdom, local knowledge and behavioural aspects with bio-medical science to find health solutions—an unheard of combination at that time.

“Ebola showed dramatically that, in contrast to prevailing medical opinion in the 1960’s and ‘70s, the world would experience a seemingly never-ending series of new infectious disease epidemics,” writes Dr Piot—a premonition that would lead him to take on one of the greatest issues of our time—the AIDS epidemic.

As the first Executive Director of UNAIDS he criss-crossed the world convincing global leaders to take on the AIDS epidemic while also working to bring the United Nations system together to support countries. Dr Piot has often said that while he was firmly established as a public health expert, he had to quickly grow into the role of politician. The book recounts how politics were played in the high stakes arena of development and global health.

The scientific nature that allowed him to make discoveries like Ebola also made him a tenacious and effective leader. He was fearless and pushed donors and national leaders to “do the right thing”.

“Peter has been successful because he has always put people first. This was true when there were precious few resources and true when the millions of dollars for the AIDS response turned to billions,” said Mr Sidibé. “He has been both mentor and friend and through his achievements, all of us have learned and benefited.”

His accomplishments have not come without regrets. Dr Piot writes in the epilogue about his last day at UNAIDS, that he was still “haunted by the question of what I could have done earlier and faster.”

Throughout his career Dr Piot has kept his sense of humour and appreciation for life intact. Whether it’s musing about mojitos with Fidel Castro in Cuba or paying his respects to Diago—a sake bar in Tokyo—his love of good food and wine and is apparent and will surely deliver a second book.

No Time to Lose will be launched in New York City at the Council on Foreign Relations on Monday, 18 June 2012.

UNAIDS Deputy Executive Director, Programme Dr Paul De Lay speaking at the launch of the East African Community (EAC) Medicines Registration Harmonization Project in Arusha, Tanzania, on 30 March 2012.

The need to ensure that people in Africa have access to essential, high quality, safe  and affordable medicines has just received a major boost with the launch of the East African Community (EAC) Medicines Registration Harmonization Project in Arusha, Tanzania, on 30 March 2012. 

The project is a high-level alliance bringing together the New Partnership for Africa’s Development (NEPAD), the World Health Organization (WHO), the Bill & Melinda Gates Foundation, the World Bank, the UK Department for International Development (DfID), and the Clinton Health Access Initiative (CHAI). The Arusha launch marks the starting point in the implementation of the broader African Medicines Regulatory Harmonization Programme across the continent.

The partners hope to strengthen regulatory capacity and systems for medicines in Africa, including antiretroviral drugs, so that fewer lives are lost due to drugs which are unsafe and of poor quality or which are largely unavailable or delivered inefficiently. These existing challenges can be attributed to a range of factors which include lack of human and financial resources, insufficient infrastructure, weak medicine legislation and a lengthy drug approval cycle caused by low regulatory capacity and inefficient processes.

“Access to safe, affordable and quality medicines for the treatment of common diseases remain out of reach to many people in the East African region as a whole,” said Dr Richard Sezibera, Secretary General of the East African Community. “The programme we are launching here today will put in place a uniform and standardized medicines regulatory framework for both good health outcomes and economic gains.”

The launch was attended by ministers, representatives from regional and pan-African bodies, international organizations and donors. One of the key arguments endorsed by those at the launch was the critical need to produce creative, African sourced solutions, responsive to the particular needs of African people.

This would encourage local production of medicines—such as antiretroviral therapy for people living with HIV—in partnership with other emerging economies like the BRICS group (Brazil, Russia, India, China, South Africa). In addition it would strengthen African control of development investments through more diversified funding sources which would reduce Africa’s dependence on external factors. 

At present, Africa is heavily reliant on imported medicines. 80% of the antiretrovirals keeping more than 5 million African people alive come from abroad.  In addition, two thirds of all AIDS expenditures in Africa come from external sources. 

According to UNAIDS Deputy Executive Director, Programme Dr Paul De Lay, who attended the launch, creating an African Medicines Regulatory Agency would allow faster roll out of drugs, stronger quality assurance, greater public confidence and the enhancement of African ownership of a sustainable AIDS response. 

(L to R) UNAIDS Deputy Executive Director, Programme Dr Paul De Lay, Ambassador Dr Richard Sezibera, Secretary General of the East African Community and UNAIDS representative for African Union.

“Regional regulatory agencies will deliver a range of benefits” said Dr De Lay. “Things will be faster, more efficient and fairer,” he added.

UNAIDS believes that such regional initiatives are an essential component of a successful response to HIV. These initiatives will provide a strong platform for advocacy, coordination and regulation to make high quality drugs more widely available across the continent.

An African Medicines Regulatory Agency would additionally allow a more rapid and far reaching response to reports of possible counterfeit or tainted drugs. It will also enhance capacity to test suspect batches of medicine. Such increased regional pharmacovigilance would protect health and save lives. It is hoped that the African Medicines Regulatory Harmonization Programme can help maintain the considerable progress made in the health sector in recent years.

Dr Ibahim Assane Mayaki, CEO of NEPAD and UNAIDS Executive Director Michel Sidibé signing the collaboration agreement at the Africa Union Headquarters in Addis Ababa, Ethiopia 27 March 2012.
Credit: UNAIDS/Jiro Ose

ADDIS ABABA, 27 March 2012—The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the New Partnership for Africa’s Development (NEPAD) Agency today signed a memorandum of understanding (MoU) calling for strategic collaboration to advance sustainable responses to HIV, health and development across the African continent. The MoU was signed by UNAIDS Executive Director Michel Sidibé and Chief Executive Officer of NEPAD Agency, Dr Ibrahim Mayaki, on the sidelines of a colloquium marking the 10^th anniversary of NEPAD in Addis Ababa, Ethiopia.

Under the terms of the agreement, UNAIDS and the NEPAD Agency will work with partners to: support the development of common African positions for the AIDS response, with an emphasis on sustainable financing; address constraints in access to HIV medicines; facilitate policies and partnerships to eliminate new HIV infections in children and improve the health of mothers; enhance country ownership and accountability; and encourage South-South cooperation.

“This new partnership will bring us one step closer to our goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths,” said the UNAIDS Executive Director, at a press conference on 27 March after the signing of the MoU. Mr Sidibé said that “getting to zero” would demand effective and inclusive partnerships, shared responsibility, greater transparency and a focus on results—areas in which NEPAD is known to excel.

Speaking alongside Mr Sidibé at the press conference, Dr Ibrahim Mayaki said that country ownership would be critical to advancing AIDS and development responses in the coming decade. “Partnerships for development can only succeed if they are led by developing countries,” said the Chief Executive Officer of NEPAD Agency. “AIDS programmes must be financially sustainable over the long term and tailored to specific national settings,” he added.

Sub-Saharan Africa carries the highest HIV burden of any region in the world. In 2010, about 68% of all people living with HIV resided in sub-Saharan Africa, a region with only 12% of the global population.

About two-thirds of all AIDS investments in Africa currently come from external sources. According to UNAIDS estimates, Africa will require between US$ 11-12 billion for its regional AIDS response by 2015—US$ 3-4 billion more than the current expenditure.

Mayor Robert Bowser (left), President of the National Conference of Black Mayors, and Dr. Djibril Diallo, UNAIDS Senior Advisor, at the World Summit of Mayors.
Credit: Logan Coles

More than 250 mayors from sub-Saharan Africa and of African descent from the United States, the Caribbean and Latin America focused on strengthening the AIDS response in urban areas during an historic conference held in Dakar, Senegal from 15-19 December.

The 2011 World Summit of Mayors Leadership Conference was hosted by Senegalese President Abdoulaye Wade and co-organized by the US-based National Conference of Black Mayors (NCBM), the National Association of Senegalese Mayors, and UNAIDS.

At a plenary session chaired by the mayors of Dakar and Abidjan, Côte d’Ivoire, delegates engaged in a discussion on HIV risks, prevention strategies and the need to end stigma and discrimination.

“Today we can say with confidence that HIV prevention programmes are producing results. We can report today that 22 countries in Africa have lowered the rate of new HIV infections by 25% since 2001”, said Djibril Diallo, UNAIDS Senior Advisor, in a statement on behalf of UNAIDS Executive Director Michel Sidibé.

Citing the challenges posed by the global financial crisis, Dr. Diallo urged municipal leaders to reinforce their efforts to find ways to take greater ownership of the AIDS response and promote shared responsibility. “This will bring the world closer to the UNAIDS vision of zero new HIV infections, zero discrimination, and zero AIDS-related deaths,” he added.

The plenary session concluded with a proposal for pilot partnerships for HIV prevention between 10 cities and towns in sub-Saharan Africa and the Americas. The proposal was incorporated in the Summit’s action plan. The municipalities will share information on their five most effective activities to reduce HIV infections and ways to increase budget allocations for HIV prevention as well as to improve prevention services. The organizers plan to enlist several large U.S. cities, such as Atlanta, Las Vegas and Washington, DC in the pilot initiative.

“The foundational belief of the Summit is that cooperation between municipalities on the development challenges facing cities on the global landscape, including the HIV epidemic, is essential to the improvement of the well-being of all citizens in urban areas,” said Mayor Robert L. Bowser of East Orange, New Jersey, President of the NCBM, whose membership includes 682 mayors with a constituency of 55 million people across the U.S.

The World Summit of Mayors was convened within the framework of the UN International Year for People of African Descent 2011. Outside of sub-Saharan Africa, an estimated 200 million people in the Americas identify themselves as being of African descent, as do millions more in other parts of the world.

The United Nations Resident Coordinator in Senegal, Bintou Djibo, saluted the Summit’s efforts to forge international partnerships for development between mayors of the Diaspora and in sub-Saharan Africa. “Cooperation between mayors can promote decentralized governance that takes local conditions into account, and advance progress towards the achievement of the MDGs by 2015,” said Ms Djibo.

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

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

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

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

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

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

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

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

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

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

More than 1 200 leading figures from the worlds of science, politics, economics and civil society are at the World Health Summit taking place from 23 – 26 October in Berlin to discuss some of the major challenges in global health today.

Under theme Today’s Science - Tomorrow’s Agenda five main issues are being addressed at the conference: the impact of climate change on health; the rapid increase in chronic diseases in developing and industrialized countries; the worldwide burden caused by mental diseases; vaccine strategies; and international health policy.

HIV featured high on the agenda as one of the greatest health crises of modern times. The urgent need to integrate HIV with other health services was stressed along with the importance of comprehensive and sustained access to health for the billions of people in need.

UNAIDS Deputy Executive Director, Programme, Paul De Lay gave the key note speech on the third day of the conference and outlined the need to successfully integrate non-communicable diseases with HIV.

“It is critical to scale up the response to infectious diseases to save millions of people,” said Dr De Lay. “This is where the AIDS response can help. Thirty years of innovation, expertise and highly developed service platforms can successfully inform and be integrated with responses for non-communicable diseases.”

Dr De Lay also chaired a working session on the role of new technologies in HIV prevention which looked at how the scientific breakthroughs of the past year have added to the set of tools available to stop HIV transmission. The session focused on how, by using the most effective set of actions within an enabling environment, numbers of new HIV infections could be significantly reduced.

“We are at a very unique time in the HIV epidemic,” said Dr De Lay. “The recent scientific advances are initiating some essential changes in HIV prevention and treatment. The main question now is one of implementation and scale up.” 

At the close of the summit a set of recommendations will be put forward to decision-makers from the relevant fields. Such recommendations will aim to address some of the urgent challenges in medical research, global health and health care delivery discussed at the conference.

Panelists at the side event “The Politics of Health” included (from left to right): Dr. Aaron Motsoaledi, Minister of Health, South Africa; Dr Jarbas Barbosa, Brazil’s Vice-Minister of Health; UNAIDS Executive Director Michel Sidibé; Ms Amina Ibrahim, Chief Executive Officer, Center for Development Policy Solutions, Nigeria.

High-level government officials, medical experts and civil society representatives from 120 countries are gathered in Rio de Janeiro, Brazil, at a three-day meeting focused on the social, economic and political conditions that drive health inequities. Convened by the World Health Organization (WHO), the World Conference on Social Determinants of Health provides a global platform for discussion on a range of topics, including early child development, universal health care, social protections, fair financing, gender equity, political empowerment and global governance.

In a panel session at the conference entitled "Politics of Health: Lessons from the AIDS movement to address the social determinants of health,” UNAIDS Executive Director Michel Sidibé emphasized the need for a greater focus on the underlying dynamics that fuel health inequities. "AIDS has taught us about the need to address social inequities that put women, children and vulnerable populations at risk for HIV," said Mr Sidibé, who chaired the session, together with Brazil's Vice-Minister of Health, Dr Jarbas Barbosa.

Dr Aaron Motsoaledi, South Africa’s Minister of Health underlined the importance of partnerships in addressing the national HIV epidemic. “We have 19 sectors represented in the South African National AIDS Council, chaired by the Deputy President. When we aim to address the social determinants of health, these groups are essential to mobilize all aspects of our society," he said.

Noting the struggle for health and human rights in Brazil, Vera Paiva, Professor of Social Psychology at the University of Sao Paolo said that the mobilization and participation of people affected by HIV has helped ensure the protection of human rights within the country’s HIV response.

Ms Amina Ibrahim—Chief Executive Officer of the Center for Development Policy Solutions in Nigeria and former Special Advisor to the President of Nigeria on the Millennium Development Goals (MDGs)—underscored that political commitment can become “lost in translation” between policy and action. To lessen the implementation gap, she said that Nigeria is devoting considerable effort to briefing ministries and parliamentarians and providing them with evidence of how investing in education, gender and other MDGs benefits their constituents.

According to WHO there is ample evidence that an individual's health status is largely determined by his or her socio-economic position. "The differences within and between countries, in income levels, in opportunities, in health status, and in access to care are greater today than at any time in recent history," said Dr Margaret Chan, Director-General of WHO, at the opening plenary of the conference. "A world that is greatly out of balance in matters of health is neither stable nor secure," she added.

During the conference, the UNAIDS Executive Director congratulated Finland’s Minister of Health, Maria Guzenina-Richardson, on her successful role as Vice-President of the Conference. They reflected on areas for mutual collaboration between UNAIDS and the Government of Finland on health promotion, young people and vulnerable populations.

In recent years, the Government of Brazil—host of this week’s conference—has made major strides in improving the health and well-being of its population. Through the publicly-funded Sistema Único de Saúde, every Brazilian is entitled to free health care, from routine check-ups to complex surgical procedures. Nearly all people living with HIV in Brazil who are eligible for antiretroviral treatment now have access. The Government has also taken bold action to address stigma and discrimination, most recently through the launch of a pioneering anti-homophobia campaign.

Speaking at the opening plenary, Alexandre Padilha, the Brazilian Minister of Health, related that in the 23 years since Brazil adopted its democratic Constitution, the country has faced many crises, but has never given up its commitment to providing universal access to medical services free of charge. Brazil, he said, would not allow the current economic crisis to change this.

Following the opening plenary, the UNAIDS Executive Director participated in a High Level Round Table alongside Dr Margaret Chan of WHO, Rebeca Grynspan of the United Nations Development Programme, U.S. Secretary of Health and Human Services Kathleen Sebelius, and Tereza Campello, the Brazilian Minister of Social Development.

Calling attention to the seismic political shifts occurring in the global North and South, Mr Sidibé noted that the old rules of development no longer apply. “The world is changing! Countries like Brazil and South Africa have shown that policies founded in respect for all of their people, and that distribute opportunity fairly, bring dynamism and growth that is good for all,” he said.

At the end of the conference, governments are expected to endorse a Rio Political Declaration on Social Determinants of Health outlining their pledges to improve the social conditions that affect people's health.

Credit: WHO/Oliver O'Hanlon

The full adoption of the new draft World Health Organization (WHO) global health strategy for HIV 2011-2015 will be a key focus of discussion at the 64^th World Health Assembly, taking place in Geneva from 16-24 May and attended by Health Ministers and officials from more than 190 countries. Intended as a global call to action, the comprehensive draft strategy maps out the WHO latest guidance and approaches to successfully challenging today’s evolving AIDS epidemic.

The World Health Assembly, the highest decision-making body of the World Health Organization which sets policy and approves the budget, will also debate a multiplicity of other issues. These include: pandemic influenza preparedness, cholera and the mechanism for control and prevention, infant and young child nutrition, youth and health risks, safe management of drinking water, climate change and health prevention and control of non-communicable diseases and malaria. The future of financing for WHO will also be high on the agenda.

Today WHO Director-General Dr Margaret Chan will address the Assembly and on 17 May invited speakers Mrs Sheikh Hasina, Prime Minister of Bangladesh, and Bill Gates, Co-chair of the Bill & Melinda Gates Foundation, will take the floor.  

Four technical meetings, ranging from public health concerns and radiation health to information and accountability for the health of women and children are also scheduled.

In addition to setting policy, the Assembly will give the gathered government representatives, medical professionals and academics the chance to exchange ideas and experiences. Regional meetings for Ministers of Health are set to provide an opportunity to explore specifically relevant issues.

Ms Helen Evans Interim Chief Executive Officer, Global Alliance for Vaccines and Immunisation (GAVI); Dr Michel Kazatchkine Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM); Ms Tamar Manuelyan Atinc Vice President, Human Development Network, World Bank; Dr Tachi Yamada President, Global Health Program, Bill & Melinda Gates Foundation; Dr Margaret Chan Director-General, World Health Organization (WHO); UNAIDS Executive Director Michel Sidibé; Mr Anthony Lake Executive Director, United Nations Children’s Fund (UNICEF); Mr Babatunde Osotimehin Executive Director, United Nations Population Fund (UNFPA).

The Health 8 group gathered at the UNAIDS Headquarters in Geneva on Wednesday 23 February to reflect and strategize on one of most pressing issues affecting the health of the world’s population—maximizing health outcomes with available resources.

The Geneva meeting, convened in this occasion by UNAIDS Executive Director Michel Sidibé, focused on how to get “more health for the money.” Participants held discussions under three main topics: the UN Secretary-General’s Global Strategy for women’s and children’s health, the role of multilateralism in the new economic order, and the provision of technical support for capacity building.

The Health 8 (H8) is an informal group of eight health-related organizations comprising WHO, UNICEF, UNFPA, UNAIDS, GFATM, GAVI, Bill & Melinda Gates Foundation, and the World Bank. It was created in mid-2007 to stimulate a global sense of urgency for reaching the health-related Millennium Development Goals and has focused on better ways to speed up efforts to bring lifesaving-health improvements to people worldwide.