Delegates from more than 300 municipalities join global Fast-Track Cities conference on urban HIV, tuberculosis, and viral hepatitis

LONDON, UNITED KINGDOM, 9 September 2019 — London Mayor Sadiq Khan today welcomed city, municipal, and global leaders to Fast-Track Cities 2019, the inaugural conference of more than 300 cities and municipalities prioritizing their responses to urban HIV, tuberculosis (TB), and viral hepatitis. Speaking at the conference, Mayor Khan highlighted the problem of health inequalities across the world, as well as the need to end the stigma still associated with HIV. He also reiterated the bold ambition for London to achieve the target of no new HIV infections, deaths, and stigma by 2030.

“I’m honoured that city and health leaders from all around the world are uniting today in London. The first international gathering of Fast-Track Cities will be a truly historic event in our fight against HIV and health inequalities,” said Mayor Khan. “I’m also proud of the work London is doing to tackle HIV and inequality, and am pleased that we will be able to share our knowledge and experience with others. But despite our progress, there is still much more to be done as too many people continue to catch the virus. To truly end all new cases of HIV in London, it’s high time the Government made PrEP available via the NHS for all those who need it. No ifs, no buts, and no more pilots – we know it works, it stops the spread of infection and saves money in the long run.”

More than half of the world’s population currently lives in urban centers where the risk of contracting HIV, TB, and hepatitis is significantly higher due to urban dynamics such as social behavior, migration, unemployment, and social and economic inequalities. However, cities and municipalities also have inherent advantages and offer important opportunities to accelerate health responses and take transformative action to ensure that equitable access to health services is available to everyone.

“We have seen that for an effective response to HIV it is critical to remove inequalities, power imbalances, marginalization, and discrimination,” said Gunilla Carlsson, Executive Director a.i., of UNAIDS, one of four core partners of the Fast-Track Cities initiative. “Cities must use their advantages to leverage innovation, create social transformation, and build equitable societies that are inclusive, responsive, resilient, and sustainable,” she added.

Organized by the International Association of Providers of AIDS Care (IAPAC), in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other partners, the Fast-Track Cities 2019 conference is being held from September 9-11, 2019, at the Barbican Centre. The conference’s aim is to highlight successes achieved across the Fast-Track Cities network, address cross-cutting challenges faced by local stakeholders, and share best practices in accelerating urban AIDS responses, inclusive of co-infectious diseases such as TB and viral hepatitis. The conference features plenary sessions, panel discussions, and abstract presentations by representatives from more than  300 Fast-Track Cities.

“Health inequalities are preventing people living with HIV, TB, and viral hepatitis, notably from disenfranchised and minority ethnic communities, from accessing the services they need to live longer, healthier lives," said Dr. José M. Zuniga, President/CEO of the International Association of Providers of AIDS Care (IAPAC), one of the core partners of the Fast-Track Cities initiative and the conference’s organizer. “We are convening in London because the city’s high level of political commitment, public health leadership, support from clinical and service providers, and engagement with affected communities have enabled the city to surpass the Fast-Track Cities’ programmatic HIV targets. We are here to shine a light on London’s efforts to reduce and eliminate health inequalities that contravene the principles of social justice.”

When London joined the Fast-Track Cities initiative in January 2018, the city had already met the UNAIDS 90-90-90 targets, which are defined as 90% of people living with HIV knowing their status, 90% of people who know their status accessing HIV treatment, and 90% of people accessing HIV treatment achieving viral suppression. FTC London, a pan-city group of stakeholders steering the city’s Fast-Track Cities engagement, has made outreach to the black, Asian, and minority ethnic (BAME) community a priority in their “London Getting to Zero” strategy.

The “High-Level Panel on Health Inequalities,” which was the official opening of the Fast-Track Cities 2019 conference, included the following elected officials:

• Kostas Bakoyannis (Mayor, Athens, Greece)
• Josefina Belmonte (Mayor, Quezon City, Philippines)
• Winston Ennis (Deputy Mayor, Kingston, Jamaica)
• Simone Kukenheim (Deputy Mayor, Amsterdam, Netherlands)
• Fernando Medina (Mayor, Lisbon, Portugal)
• Svante Myrick (Mayor, Ithaca, NY, USA)
• Robb Pitts (Chairman, Fulton County, Atlanta, GA, USA)
• Mykola Povoroznyk, (First Deputy Mayor, Kyiv, Ukraine)
• Gennadiy Trukhanov (Mayor, Odesa, Ukraine)

In addition to IAPAC’s Dr. Zuniga, and UNAIDS’ Ms. Carlsson, several global public health leaders also participated in the “High Level Panel on Health Inequalities,” including: 

• Amb. Deborah L. Birx (US Global AIDS Coordinator, PEPFAR)
• Cary James (CEO, World Hepatitis Alliance)
• Suvanand Sahu (Deputy Executive Director, Stop TB Partnership)
• Maimunah Mohd Sharif (Executive Director, UN-Habitat)
• Trevor Stratton (Board Member, GNP+)
• Marijke Wijnroks (Chief of Staff, Global Fund to fight AIDS, TB and Malaria)

The panel was moderated by UK-based broadcaster and former BBC journalist Henry Bonsu.

Press passes for Fast-Track Cities 2019 are available by contacting IAPAC Director of Communications Zack Pesavento at zpesavento@iapac.org.

The conference program is available at: https://www.iapac.org/conferences/fast-track-cities/#program

About the International Association of Providers of AIDS Care (IAPAC)

With more than 30,000 members globally, IAPAC is the largest association of clinicians and allied health professionals working to end AIDS as a public health threat by 2030. For more information about IAPAC and our global activities, please visit: https://www.iapac.org/

About the Fast-Track Cities Initiative

Fast-Track Cities is a global partnership between almost 300 cities and municipalities, the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Human Settlements Programme (UN-Habitat), and the City of Paris that are collaborating to end the epidemics of HIV, TB, and viral hepatitis by 2030. The initiative was launched on World AIDS Day 2014 in Paris. For more information please visit: https://www.iapac.org/fast-track-cities/about-fast-track/

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

When her husband came home with a positive HIV test, Jokapeci Tuberi Cati decided that she wanted to get tested too.

“Fear of the unknown, of the stigma associated with HIV and of rejection were all going through my mind before the test,” she said.

Once she got tested in Lami, Fiji, she sighed and said to herself, “done and dusted.”

But she had a nagging thought that her test would be positive and she started thinking about a coping mechanism. She kept playing over and over the same scenario, with one question: how will she live from this point onward?

“In fact, little happened in reality,” Ms Cati said. She recounted that an experienced doctor treated her with the utmost care when he informed her of her HIV-positive status.

She returned home and decided that she and her husband would bear the diagnosis together as a couple. No one needed to know anything.

With time, Ms Cati learned to cope with her new status and vowed to accept her new life. She now wanted to help people to understand the issue so that they would not go through the same experience.

But first she had to let people know.

“The moment I decided to disclose my HIV status to my family and friends, there was a different magnitude of support,” she said. Thinking back to 20 years ago, she still cannot forget how people reacted with such warmth.

That emboldened her to become much more proactive and share her story with a greater number of throughout the country. She is now a programme manager at the Fiji Network for People Living with HIV. Despite losing her husband, Ms Cati is thankful she found out about her status, because with medication she did not transmit HIV to her children.

“Better to know than not know—the benefits are huge,” she said.

Ukraine has announced that it is to allocate $16 million to the country’s AIDS response for 2019-20, which will sustain and expand HIV prevention and support services for key populations as well as care and support services for people living with HIV.

The procurement of HIV services for key populations and people living with HIV from suppliers, including non-governmental organizations, will be managed by the Ministry of Health’s Centre for Public Health, using public procurement procedures. The new process will begin in July.

The move is an important part of Ukraine’s transition from donor funding to a nationally funded AIDS response.  

"Ukraine has taken an important step towards moving from international funding to a nationally coordinated policy and ownership,” said Vladimir Kurpita, director of the Centre for Public Health at the Ministry of Health.

The list of services covered by the new policy includes targeted HIV information services and consultations, harm reduction programmes, including needle exchange and distribution, the distribution of condoms and lubricants, HIV testing and screening for tuberculosis. Key populations prioritized include gay men and other men who have sex with men, sex workers, and people who inject drugs. HIV care and support services include strengthening treatment adherence and retention under medical supervision and the involvement of partners of people living with HIV in health care services.

Mr Kurpita promised a smooth transition and said that the government would procure quality-assured services from local non-governmental organizations with the relevant experience and capacity to deliver.

“Nobody who was reached through prevention, support and care services that were funded by external donors should ever be cut off from the transition to government support,” he said.

The head of the All Ukrainian Network of People Living with HIV, 100% Life, Dima Sherembey, encouraged everyone to engage in the process.

"If you are an NGO service provider, engage in bidding; if you are a representative of the donor community in Ukraine, motivate your partners and subcontractors on the ground; and if you have resources and knowledge, provide technical support and assistance to bidders so that they can be successful recipients and implementers of this important wave of government funding,” he said.

UNAIDS country director Roman Gailevich welcomed Ukraine’s commitment to increase domestic funding for the AIDS response.

“We are entering a new era of the national response to HIV in Ukraine,” he said. “We hope Ukraine will not only show that this new model of procurement of HIV services is viable, but that it will also serve as an example to other countries in the region.”

“I thought I could never be happy again,” said Mei Zi, who is living with HIV and a mother of a lively young boy. She calls her son “calm angel”, as he doesn’t talk much. Mei Zi says that “calm angel” as a gift from God.

Mei Zi met her husband two years after she discovered that she was living with HIV. After their wedding, she went to live with her husband in Beijing, China, where he worked. She remembers receiving a red down jacket as a present from her husband when she got off the train in Beijing. The excitement is still fresh, even though it was a long time ago. 

Soon after her marriage, Mei Zi became pregnant. Although her doctor advised her that she could take medicine to ensure that her baby was born free from HIV, she made the painful decision to terminate the pregnancy. She and her husband were both living with HIV and, in addition, she was living with hepatitis C.

Mei Zi put having children out of her mind, but five years later a test showed that she was pregnant.

Mei Zi was treated just like any other expectant mother at the hospital. She decided to take treatment to stop her baby becoming infected with HIV and to treat her hepatitis after the baby’s arrival.

Because of the hepatitis, Mei Zi had a cesarean section in the 34th week of her pregnancy. She was afraid of the surgery, but eager to see her baby.

“As the door of the operating room was pushed open, I started crying,” said Mei Zi. “I felt the door was just like between life and death.” When the doctor presented her with the new arrival, she could not believe it was true―a healthy baby boy, free from HIV.

The Women’s Network against AIDS in China (WNAC) is striving to ensure that more women living with HIV and hepatitis C are aware that they can have healthy children and receive the support to do so.

WNAC was established in 2009 with assistance from UNAIDS and consists of 27 women’s community organizations across 12 provinces in China. It is a platform that brings together and advocates for women living with HIV and ensures that women living with HIV get the help and support they need to access appropriate health care and give birth to babies free from the virus.

Mei Zi achieved her dream of having a healthy baby, but it was not by chance. The support she received from her health-care provider, WNAC, organizations in the network and many other community groups made it possible.

“Calm angel” is now four and a half years old and energetic and curious about the world.

User fees and other out-of-pocket expenses―defined as direct payments made by people to health-care providers at the time of service use―are a major barrier to people getting tested for HIV, to people living with HIV being treated and to people living with HIV being retained in treatment and care.

Even if antiretroviral medicines are available free of charge, fees for diagnostic tests, consultations and medicines for opportunistic infections have a huge impact on people living on a lower income. User fees have also been shown to reduce access to health services more broadly among the more vulnerable within society. Out-of-pocket payments make up substantial proportions of total health expenditure in all regions, and in some low- and middle-income countries private out-of-pocket spending is estimated to account for more than 60% of total health expenditure.

According to the World Bank, around 3.4 billion people globally who earn US$ 5.50 a day or less are just one medical bill away from sinking into poverty.

The Government of Côte d’Ivoire has signalled its commitment to stop people being charged for accessing HIV testing and treatment services, declaring that it will strictly apply previously announced decisions to prevent people living with or affected by HIV being asked to pay user fees.

A note circulated by the Ministry of Health has reminded all service providers that costs for HIV testing and treatment services should not be charged to people accessing those services. The directive applies for all services for pregnant and breastfeeding women, all HIV testing services, tests for viral load suppression and the prescription of antiretroviral medicines for people living with HIV.

The directive also reminds service providers that children under the age of 15 years should have free access to health services and that young women aged 15–24 years should have free access to primary health care, HIV testing and family planning services.

In several countries, the issue of user fees has been identified as a major barrier to testing people for HIV, to treating people living with HIV and to retaining people in treatment and care.  

The renewed commitment of Côte d’Ivoire to confront the issue of user fees followed discussions between the President of Côte d'Ivoire, Alassane Ouattara, and the former President of Botswana, Festus Mogae, who visited the country in March in his capacity as Chairperson of the Champions for an AIDS-Free Generation in Africa.

Following their discussions, the government also announced its intention to increase domestic funding for the AIDS response by US$ 10 million in the next budget.

During his meeting with the President, Mr Mogae congratulated Mr Ouattara and the First Lady, Dominique Ouattara, for their personal commitment to ending the AIDS epidemic as a public health threat by 2030. Ms Ouattara is UNAIDS Special Ambassador for the Elimination of Mother-to-Child Transmission and the Promotion of Paediatric Treatment of HIV.

At the conclusion of his mission, Mr Mogae underlined the importance of accelerating the response to the epidemic. “We cannot be complacent and allow the huge improvements that we have made so far to be lost. If we stop now, we will lose everything we have already invested and achieved. The entire nation must be mobilized to ensure that no one is left behind,” he said.

There were 500 000 people living with HIV in Côte d’Ivoire in 2017, with around 46% accessing HIV treatment. 

While the intention of age of consent laws for medical services is often to protect children, in practice such laws do the opposite, by discouraging adolescents from accessing the services they need to stay healthy.

Age of consent laws for medical services require people aged younger than 18 years to obtain permission from a parent or guardian before accessing sexual and reproductive health services, HIV testing and treatment, pre-exposure prophylaxis and other health services. They particularly affect adolescent girls, whose sexuality tends to be stigmatized and who bear the physical and social burdens of unwanted pregnancies.

In 2017, 78 of 110 reporting countries stated that they required parental consent for a child under 18 years to access HIV testing, and 61 of 109 reporting countries required parental consent for HIV treatment. In addition, 68 of 108 reporting countries required parental consent to access sexual and reproductive health services.