A new tool to track progress and identify gaps in health programming in Zambia has been launched. The Zambia Integrated Health Situation Room centralizes data for HIV, tuberculosis, maternal and child health and malaria to improve programming and reach more people with services.

The situation room—the first integrated situation room in Africa—was launched on 6 March by Inonge Mutukwa Wina, the Vice-President of Zambia, and Michel Sidibé, the Executive Director of UNAIDS. It shows real-time service delivery data and produces a comprehensive picture of key health areas in Zambia.

Enabling quick feedback on results at the county and community levels, the situation room identifies bottlenecks to service delivery. It also enables programme staff to intensify local efforts to ensure that adults and children living with HIV have regular access to care and that HIV medicines are replenished quickly if stock-outs occur.

Earlier in the day, Mr Sidibé congratulated Edgar Chagwa Lungu, the President of Zambia, for his government’s leadership in ensuring that no one is left behind by the AIDS response in Zambia. Mr Lungu expressed his commitment to ensuring access to medicines and expressed his commitment to local pharmaceutical production. He reiterated his commitment to not only reach the 90‒90‒90 targets, but to make the target of reaching 100% of people living with HIV in Zambia a reality.

Quotes

On World AIDS Day, the President of France, Emmanuel Macron, led by example by taking a HIV test.

Mr Macron and the First Lady of France, Brigitte Macron, visited a hospital in Saint Denis in northern Paris that caters to people in vulnerable situations, including migrants. Speaking after taking the HIV test, Mr Macron said, “We have not won the battle against AIDS. We need to protect ourselves, get tested, get treated and accept those in society who have HIV.”

Globally today, 40% of people living with HIV don’t know their HIV status. In France, one in five people living with HIV do not know their HIV status. The majority of new HIV infections in the country occur among gay men and other men who have sex with men.

“Emmanuel Macron is showing leadership in action. By publicly taking an HIV test, he has demonstrated French leadership on the right to health,” said Michel Sidibé, UNAIDS Executive Director. “France is a valued partner of UNAIDS.”

Earlier, on 28 November, Mr Macron renewed his commitment to the global AIDS response during a speech to young students at the University in Ouagadougou, Burkina Faso.

France has played a critical role in ensuring access to medicines globally through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which it has donated more than US$ 4.8 billion. France also supported the creation of UNITAID in 2006.  

These investments have yielded substantial results. Through global solidarity today nearly 21 million people have access to HIV treatment. In 2016, 53% of people living with HIV were on treatment. 

Prévenir, dépister, continuer à soigner. #WorldAIDSDay pic.twitter.com/y2VTZitiOY

— Emmanuel Macron (@EmmanuelMacron) December 1, 2017

Zambia has launched its AIDS Response Fast-Track Strategy 2017–2021, which provides a road map to achieve the global Fast-Track prevention and 90–90–90 targets whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

Building on the results achieved so far, the strategy has three main objectives: establish clear approaches to accelerate the HIV response for everyone, including key populations; set yearly targets at the national and provincial levels; and estimate costs and the resources gap.

So far, the government’s commitment has had significant impact: new HIV infections have decreased from 69 000 in 2005 to 59 000 in 2016 and coverage of pregnant women receiving antiretroviral medicines to prevent mother-to-child transmission of HIV has increased to 87%. Efforts to reach the most vulnerable people are being made, and new national policies outline targets and strategies to intensify prevention services in all the 10 provinces of the country.

The strategy provides for specific facility-based and community-led programmes, such as accelerating HIV testing and counselling in districts with high HIV prevalence, targeting key populations and integrating testing with other health-care services. 

The strategy will guarantee access to HIV treatment and care services and improve HIV testing services. One of the treatment goals emphasized in the strategy is the total elimination of new HIV infections among children.

The strategy was developed by a technical task team led by the National HIV/AIDS/STI/TB Council and UNAIDS.

Quotes

Michel Sidibé, the Executive Director of UNAIDS, has urged international health leaders to prioritize health development. While giving his keynote address at the opening ceremony of the Belt and Road High Level Meeting for Health Cooperation: Towards a Health Silk Road, Mr Sidibé also expressed to the Vice-Premier of China, Liu Yandong, his appreciation for China’s efforts through the Belt and Road initiative to create greater cooperation for better health and highlighted the ongoing work to strengthen China–Africa health connections.

More than 20 ministers and deputy ministers of health and the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, attended the meeting, which was held in Beijing, China, on 18 and 19 August. The meeting looked at ways to collaborate across shared health goals, including innovation and technology, vaccine safety, nutrition, maternal and child health and human resources for health.

A communiqué issued at the end of the meeting commits China to support UNAIDS in its work in related fields and includes concrete actions and deliverables, including the creation of a public health cooperation network and an alliance for sustainable health development. 

China’s Vice-Minister of Commerce, Wang Shouwen, commended UNAIDS’ contribution to supporting China’s engagement with Africa and committed to strengthening cooperation with UNAIDS.

UNAIDS and the National Health and Family Planning Commission of China adopted a memorandum of understanding that enhances cooperation on the implementation of the Belt and Road initiative and the 2030 Agenda for Sustainable Development and aims to enhance the effectiveness of the global response to the AIDS epidemic. Both parties agreed to use the Belt and Road initiative as a catalyst and accelerator for the Sustainable Development Goals and achieving the global Fast-Track targets by 2020, including reducing new HIV infections and AIDS-related deaths to fewer than 500 000 globally and eliminating HIV-related stigma and discrimination. The five-year agreement includes an annual US$ 1 million contribution to UNAIDS.

Quotes

Ministers of health of the Group of Twenty (G20) member countries will meet for the first time in Berlin, Germany, on 19 and 20 May to discuss a coordinated global response to global health challenges. The G20 member countries are focusing on global health for the first time, reaffirming their commitment to translating the 2030 Agenda for Sustainable Development into practice in the health and development sectors.

Health is key to the three main pillars of Germany’s G20 presidency—building resilience, improving sustainability and assuming responsibility.

Global health concerns, such as infectious disease outbreaks and antimicrobial resistance, will be the main topics of discussion, given their severe impact on the lives and well-being of millions of people as well as on the global economy. The G20 health ministers will focus on the need for strengthening health systems to ensure healthy populations, underpin strong economies and safeguard against disease outbreaks with pandemics.

Collective action and sustained leadership will be needed to address critical global health issues, including ending AIDS as a public health threat by 2030. The G20’s role will be pivotal to developing concerted action to address HIV in G20 countries—where 15.4 million people are living with HIV and nearly a million became newly infected with HIV in 2015—as well as championing global solidarity to accelerate progress globally. Currently, G20 countries provide 84% of the total official development assistance for AIDS in low- and middle-income countries.

Investing in the AIDS response will have a multiplier effect on G20 priorities as it will spur progress on tuberculosis, strengthen health systems, create jobs and drive results across the Sustainable Development Goals.

South Africa has made great strides in its AIDS response—it has the largest HIV treatment programme in the world, with more than 3.3 million people on antiretroviral therapy, funded almost entirely from domestic sources; AIDS-related deaths have declined by more than 55% since 2005; and around 95% of all pregnant women living with HIV in South Africa now have access to medicines to reduce the risk of transmitting HIV to their child.

South Africa is continually striving to do more to stop new HIV infections and prevent AIDS-related deaths and on 31 March launched its third five-year South African National Strategic Plan on HIV, Sexually Transmitted Infections and Tuberculosis (2017–2022). The plan was launched at a special event in Bloemfontein, the judicial capital of South Africa, by Deputy President Cyril Ramaphosa. The Executive Director of UNAIDS, Michel Sidibé, was present at the event to show his support for the new plan. 

In the plan are a set of bold and ambitious targets which include reducing new HIV infections from 270 000 to less than 100 000 per year, reducing new tuberculosis (TB) infections from 450 000 to less than 315 000 per year and reaching the 90–90–90 targets—whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—by 2020.

To achieve the targets the government and partners will use a combination of high-impact programmes in the locations and among the populations most affected by HIV. The plan also outlines a special focus on HIV prevention among adolescent girls and young women, who have the highest rates of new HIV infections in South Africa—100 000 young women became newly infected in South Africa in 2015.

South Africa is also stepping up its efforts to treat TB. Most AIDS-related deaths in South Africa are due to TB, and in recent years South Africa has experienced a new epidemic of multidrug resistant and extensively-drug resistant TB. As part of plans to dramatically improve adherence and drug resistance issues, the Minister of Health, Aaron Motsoaledi, recently launched a new nine-month drug regimen to treat multidrug resistant TB. 

Quotes

The first thing you notice about Colonel Alain Azondékon is that he is always moving. He is tall, head and shoulders above most people, and he uses his whole body to express his feelings. So it will come as no surprise to learn that he ends every sentence with, “Let’s go!”.

The Director of Camp Guezo, the paediatric HIV hospital in Cotonou, Benin, the Colonel has started a new movement for putting young people and families at the centre of care.

After observing traditional check-up visits, he noticed that the children were separated from their mothers by a curtain during the examination. He rearranged the furniture, making sure that the examination table was parallel to where the parents were sitting, so they could always be in eye contact with their little ones and with the doctors and nurses.

That was just the beginning. He noticed that the young people under his care needed more than medicines to lead healthy lives. He introduced psychosocial support to address the stress of living with HIV through adolescence and created a network of young people living with HIV, run by a young man who is also living with HIV.

Talking with the Colonel you get the sense that he has tried to think of everything. “A mother never comes alone,” he pointed out. “She has her children, sometimes the father comes and she has her handbag, which contains her “life”.”

The Colonel made sure that instead of chairs in the examination and therapy session rooms there were small sofas—enough places for the family as well as the mother and her handbag.

It’s the small details, as well as the big mandate, that have made Camp Guezo so successful. Children born with HIV have received care from birth. The paediatric hospital has been able to reduce mortality rates among children living with HIV from 30% to less than 5%.

Some of the patients are now adults with children of their own and have very little interest in moving to the regular health-care system.

“They sometimes call me Papa, and they ask why Papa do we have to go to the other clinic where they don’t know me,” he said.

Soon patients of Camp Guezo could find it easier to transition to other health-care facilities. The Colonel has been asked to help replicate this model in other clinics in Benin.   

“This is the kind of people-centred approach Africa and the world is looking for,” said Michel Sidibé, the Executive Director of UNAIDS, as he toured the centre. “Precious resources have been carefully put to work to keep families in a safe environment where they can get the care and support they need.” 

There are an estimated 69 000 people living with HIV in Benin. The number of new HIV infections among children continues to fall as pregnant women living with HIV gain access to life-saving antiretroviral medicines to stop babies from becoming infected during childbirth and breastfeeding.

A panel of seven speakers discussed the United Nations General Assembly High-Level Meeting on Ending AIDS, which was held in New York, United States of America, from 8 to 10 June. Entitled “Bottom-up and top-down: from national to global policy work and back,” the discussion was held on 20 July at the 21st International AIDS Conference, being held in Durban, South Africa.

Javier Belloqc, who as Co-Chair of the High-Level Meeting AIDS Stakeholder Task Force, noted that the Civil Society Hearing and the zero draft of the Political Declaration on Ending AIDS were part of the “honeymoon period” of the process. Community representatives spoke effectively on a range of priorities at the Civil Society Hearing and ensured that the zero draft included strong language on human rights, key populations and other issues. However, some of this language was lost and he found the process of developing the Political Declaration less and less transparent.

Lambert Grijns, an ambassador from the Netherlands, pointed out many of the positive aspects of the Political Declaration, including language on human rights, eradicating stigma, harm reduction and gender-based violence and the first use of the word “transgender” in a United Nations declaration. However, he identified several areas that fell short, including on key populations and comprehensive sexuality education.

Luiz Loures, Deputy Executive Director of UNAIDS, said he was pleased with the very bold Political Declaration targets on prevention and treatment, including treatment access for children, and on new technologies such as pre-exposure prophylaxis, but was disappointed by the absence of key populations being explicitly a part of the Political Declaration.

Louise van Deth of Stop AIDS Now! asked how civil society can influence United Nations diplomats in New York. Nadia Isler, Counsellor, Permanent Mission of Switzerland to the United Nations, noted that there is no recipe for influencing decision-makers, in part because the world is constantly changing.

Alessandra Nilo of Gestos noted that the High-Level Meeting on Ending AIDS happened because civil society demanded that it happen and that the recognition of transgender people was groundbreaking. She added that the next step would be to translate the Political Declaration into progress in countries and to work at the national level.  

Quotes

During a visit to Swaziland, UNAIDS Executive Director Michel Sidibé met His Majesty King Mswati III and discussed the country’s ongoing response to the AIDS epidemic. Mr Sidibé commended His Majesty for his personal leadership and commitment to Fast-Track the end of the AIDS epidemic.

Mr Sidibé praised the country for increasing domestic resources for the AIDS response through the Swaziland HIV Investment Case. As investment is scaled up, more people are accessing antiretroviral therapy, with coverage estimated at 60% of adults and 43% of children living with HIV.

Swaziland has also successfully expanded services to prevent mother-to-child transmission of HIV, with new child HIV infections reduced by 63% between 2009 and 2014. The country has achieved the goal of 90% of pregnant women living with HIV receiving antiretroviral medicines. This should further reduce the mother-to-child transmission of HIV rate, which stands at 1% at six weeks of age and 8% at the end of breastfeeding.

During his visit, Mr Sidibé also met the acting Prime Minister, Paul Dlamini, and the Minister of Health, Sibongile Ndlela Simelane. He underlined the importance of leaving no one behind in the AIDS response, including women, girls and key populations, and stressed the importance of prevention in the ongoing response to the epidemic.

During the courtesy call to the King, Mr Sidibé invited His Majesty to attend the United Nations General Assembly High-Level Meeting on Ending AIDS, which will take place from 8 to 10 June in New York, United States of America. 

Quotes