UNAIDS Executive Director Michel Sidibé (left) participates in a World AIDS Day event in Pétionville, Haiti, along with United States Ambassador to Haiti, Pamela White, and Haiti’s First Lady, Sophia Martelly.

On one level, Haiti’s HIV response parallels its earthquake recovery. Although the task is far from over, national and international stakeholders have collaborated to confront the challenge and important gains have been made.

During a World AIDS Day commemoration in Pétionville, Haiti, hosted by the Ministry of Health, UNAIDS Executive Director Michel Sidibé congratulated the country on its progress toward the vision of “getting to zero:” zero new HIV infections, zero discrimination and zero zero AIDS-related deaths.

Over the past decade, the rate of new HIV infections in Haiti fell by 54%. From 2005 to 2011, there was a 47% national decline in AIDS-related deaths. By 2011, 58% of Haitians living with HIV were accessing antiretroviral therapy. Mr Sidibé expressed optimism that this positive trajectory would continue.

“I was honoured yesterday to meet the President of the Republic and I can tell you that during our conversation, it was obvious that he wanted to put AIDS at the centre of his efforts to ensure that all people have access to the information and support systems necessary for life,” Sidibé said.

These efforts, said Mr Sidibé, must focus on the country’s most vulnerable. An estimated 18% of men who have sex with men and 8% of sex workers in Haiti are living with HIV.  Nearly half of young Haitians living in camps do not have adequate knowledge about HIV.

Mr Sidibé urged Haiti’s leaders to boost efforts to reach populations at high risk of HIV infection with prevention and treatment services. He called for the passage of an HIV law that would signal zero tolerance for stigma and discrimination.

Mr Sidibé also urged the leadership of Haiti to increase domestic investments for the HIV response. Currently, more than 75% of funding for Haiti’s HIV response comes from external sources. By taking greater ownership of its national AIDS response, Haiti would join the worldwide paradigm shift “from charity to global solidarity,” said the UNAIDS Executive Director.

During the World AIDS Day ceremony, Haiti’s First Lady, Sophia Martelly, acknowledged the complex network of social issues that increase people’s risk of HIV. “Wherever educating children is problematic, there will be AIDS. Wherever basic social needs are not met, there will be AIDS. Wherever there is violence and rape, there will be AIDS. That is why there must be an in-depth approach to prevention,” said the First Lady.

“I am proud to be working alongside the President of the Republic to guarantee education for all, the strengthening of our health care system, women's empowerment and improved living conditions for the whole population,” she added.

Haiti President Michel Martelly (left) and UNAIDS Executive Director Michel Sidibé at the Ministry of Planning in Port-au-Prince.
Credit: UNAIDS

The President of Haiti ushered in World AIDS Day 2012 commemorations with a note of hope. “It would be a very beautiful success story if we could pull off an HIV-free generation,” declared President Michel Martelly, in a meeting on 30 November with UNAIDS Executive Director Michel Sidibé.

In 2011, an estimated 77% of pregnant women living with HIV in Haiti had access to services that prevent mother-to-child transmission (PMTCT) of HIV. Between 2009 and 2011 the country secured a 25% decrease in the number of children born with HIV.

“Getting to zero HIV infections in children should be the legacy of this administration,” said Mr Sidibé. “It would be a very powerful accomplishment. Two children are born with HIV in Haiti each day. Think of what it would mean if we could leave behind a generation that was born HIV-free,” he added.

President Martelly noted the moral and economic imperatives of preventing HIV in children, saying that while it costs only US $150 to prevent a child being born with HIV, it would cost hundreds of thousands of dollars to treat a person living with the virus over the course of their lives. “If you can save a mother,” he added, “you prevent a child from becoming an orphan.”

In separate meetings with Haiti’s First Lady, Sophia Martelly, and the Minister of Health, Florence Guillaume Duperval, Mr Sidibé stressed that Haiti has the potential to eliminate HIV in children and dramatically reduce AIDS-related deaths in mothers. The First Lady pointed to national efforts geared toward achieving these twin goals, including a campaign to ensure that more pregnant women—particularly those living in rural areas—access HIV testing and treatment services.

Haiti First Lady Sophia Martelly (left) and UNAIDS Executive Director Michel Sidibé at Haiti's National Palace in Port-au-Prince.
Credit: UNAIDS

The Caribbean has the highest PMTCT coverage of any developing region. Many smaller Caribbean countries are already close to eliminating new HIV infections among children. Further scale-up of PMTCT services in Haiti—one of the region’s most populous countries—will help the entire Caribbean reach closer to the goal of eliminating new HIV infections among children, a key target of the 2011 Political Declaration on HIV/AIDS.

In addition to PMTCT scale-up, Haiti has progressed in other areas of its national HIV response.  Between 2001 and 2011, for example, new HIV infections in the country declined by 54%. Haiti also attained a 47% decline in AIDS-related deaths from 2005 to 2011.

Zambian delegation with staff from the Kenya Medical Research Institute, A drop-in Centre at Mtwapa, Mombasa.

South to South learning—or the cooperation between low- and middle-income countries—can help countries understand how to respond to HIV, particularly in politically and culturally sensitive areas such as developing programmes for key populations at higher risk of HIV infection.

From 24- 28 September 2012, members of the National AIDS Council of Zambia, with support from the country’s United Nations Joint Team on AIDS, visited to Kenya to learn about their HIV programmes to reach key populations including sex workers, people who inject drugs, men who have sex with men and transgender people.

Despite both countries having restrictive legal environments which criminalise sex work, same sex sexual relations and drug use, Kenya has long recognized its complex HIV epidemic among key populations—which accounts for 33% of new HIV infections. The country put in place a technical working group within the ministry of health to develop programmes that meet the needs of most at risk populations.

“The Modes of Transmission Study done in 2009 clearly showed that we needed interventions for key populations if we were to have a significant impact on the epidemic,” said Dr Orago, Director of the National AIDS Control Council in Kenya.

Zambia’s National AIDS Strategic Framework has recognized the need to gather more information on the epidemic among key populations. Two studies are currently planned to collect the required information. However, HIV programmers recognize that having this information is just one step towards getting key populations the services they require. It will take much longer to address the stigma and discrimination towards these key populations entrenched in Zambia’s society. 

Kenya’s political leadership was seen as a key element that has contributed to focus the AIDS response on key populations despite the existence of a non-supportive social environment. In October 2010, for example, the Minister of special programs Esther Murugi opened the national symposium on “Most at Risk Populations” in the country where she recommended more tolerance and acceptance towards men who have sex with men. Also, prominent parliamentarians have long supported the implementation of programmes focusing on people who use drugs in the coast province. “It is clear from what we have seen in Kenya that we need to organize stakeholders and to establish a mechanism that will help us mobilize political support at the highest levels,” said Harold Witola of the Zambian National AIDS Council.  

The cornerstone of the response in Kenya is a partnership framework between Government, NGOs and organized key population groups. Kenya has reached a stage in the response where the Government and its partners are implementing evidence-based HIV programmes that focus on the needs of key populations at higher risk. These include purchasing and distributing condoms and water-based lubricants for men who have sex with men and sex workers; developing HIV prevention information materials specifically for key populations; and designing a programme to make disposable syringes available for people who use drugs.

The Zambian delegation, which included HIV programmers and decision-makers from different Government departments as well as civil society and UN partners, visited a range of programmes to understand how Kenyan service providers work within the national policy and legal framework to provide an effective package of HIV-related activities for key populations.  

They visited two peer support programs for people who use drugs, a government clinic in Nairobi that focus on sex workers and men who have sex with men, an NGO clinic for male and female sex workers, and a peer support group for men who have sex with men. They also met with members of the media to identify ways to leverage its advocacy capacity and support.

The team also held community level discussions with groups of men who have sex with men, sex workers (female and male), people who inject drugs and truck drivers. “What strikes me is the excitement and commitment of everyone that we have met, including Government officials, civil society members and the beneficiaries of these services to respond to the public health needs of these important groups in the response to AIDS,” said Dr Mwango as Team Leader for the Zambia Team. 

Focusing on the health needs of key populations is an essential human right, fundamental to protecting the public health and critical to reaching the goal of universal access to HIV prevention, treatment, care and support. The Zambia Team left Kenya with a resolve to make a difference for the lives of Zambians who are at the most risk of becoming infected with HIV.  “It is not going to be easy, but we have seen in Kenya that it can be done” said Helen Frary, UNAIDS Country Coordinator for Zambia.

François Hollande at the opening ceremony (Joseph Moura/OIF)

At the opening of the XIV Francophonie Summit, held from 12 to 14 October 2012 in Kinshasa, the Democratic Republic of Congo, French President François Hollande confirmed the commitment of France to continue the development of innovative financing through taxes, like the tax on airline tickets, and those on financial transactions which are already in place. The President of France aims to increase the financial potential of these tools, and encouraged European countries to join these mechanisms, whose revenues are "directly allocated to the fight against AIDS," he said. This strong commitment to finance the AIDS response by President Hollande reflects the policy of "shared responsibility" advocated by UNAIDS, which calls on international donors, including members of the Francophonie, to honour their commitments.

The opening of the Summit also featured the establishment of a "Forum of Francophone Women", uniting more than 500 women in 2013. With this initiative, France emphasizes its commitment to the fight for violence against women, who are "the first victims of violence and war," according to President Hollande, and echoed the position of UNAIDS that ending violence against women is essential to reduce HIV transmission. Underscoring the unchangeable status of the Congolese borders and the need for peace in North and South Kivu, President Hollande stressed that any conflict is an obstacle to development and the advancement of health.

This view was also emphasized by Macky Sall, the President of Senegal, who highlighted the importance of peace and democracy in achieving the Millennium Development Goals 4, 5 and 6. Abdou Diouf, Secretary General of the International Organization of the Francophonie, also made a call to respect the choices made by citizens.

The speeches delivered by Heads of States at the opening echoed the key messages delivered on the eve of the Summit by Michel Sidibé, Executive Director of UNAIDS, when he launched the report "Decision Point La Francophonie: No New HIV Infections, No One Denied Treatment." Sidibé highlighted that Francophonie member states have made progress towards the goals of the UN 2011 Political Declaration on HIV/AIDS, but that "the access to HIV treatment in the Francophonie countries of sub-Saharan Africa (43%) is lower than among non-Francophonie countries in the same region (59%). "Innovation in the most advanced countries of the Francophonie should benefit the poor," he said, stressing that "Francophonie countries in sub-Saharan Africa should also increase the proportion of their investments in AIDS as a proportion of their economic growth and the burden of disease."

The concept of shared responsibility advanced in this report was reflected by President Hollande's commitment to innovative financing and by other initiatives highlighted by Michel Sidibé. Equatorial Guinea is now providing 100% of the funding to cover the cost of HIV treatment, Congo has committed to increase its domestic funding by 50%, and Burkina Faso has committed to double its investments in AIDS. During Michel Sidibé's meeting with Prime Minister Matata Poyo and Health Minister Felix Kabange Numbi of the Democratic Republic of Congo, they confirmed the commitment of President Kabila to reach an AIDS-free generation, and increase the government’s share of the national AIDS response from 3% to 6% in 2013.

UNAIDS Executive Director Michel Sidibé with Mr. Abdou Diouf, Secretary General of the Francophonie

Minister Yamina Benguigui, France's Minister for la Francophonie, who also participated in the launch of the report, noted that France's contribution to international AIDS response will not diminish. Minister Benguigui also highlighted the importance of collaboration with UNAIDS to develop programmes that will preserve the rights and dignity of women in the Global Forum of Francophone Women.

At the summit, UNAIDS opened its booth in the Francophonie Village, which featured information and documentation for Summit participants. The booth was visited by Abdou Diouf, Secretary General of the OIF, and Youssou N'Dour, Senegal's Minister of Culture, both accompanied by Michel Sidibé.

As host of the Summit, the city of Kinshasa launched a public campaign reflecting the theme "The Francophonie and an AIDS-free generation", which featured three messages: "One million people waiting for access to HIV treatment," "Elimination of HIV transmission from mother to child is possible," and "Shared Responsibility and Global Solidarity. " These key UNAIDS messages were on display during the opening ceremony of the Francophone Summit.

In a meeting on 12 October with the Prime Minister of Democratic Republic of the Congo (DRC), Matata Ponyo Mapon, UNAIDS Executive Director praised DRC’s leadership for organizing the 14th Summit of La Francophonie, which will be held in Kinshasa from 13-14 October.

Mr Sidibé congratulated the Prime Minister for supporting an increase in the national budget for the HIV response and encouraged his government to step up country-wide efforts to prevent new HIV infections among children. Prime Minister Mapon pledged, together with the Ministry of Health, to create a favorable national environment to eliminate new HIV infections among children.

According to government figures, nearly 1 million people are living with HIV in the DRC. Despite progress in the national HIV response, only 12% of people eligible for antiretroviral therapy are receiving it. Coverage of services that prevent new HIV infections among children is especially weak, at about 5%.

In a meeting on 11 October at the Presidential Palace in Brazzaville, UNAIDS Executive Director Michel Sidibé praised Congolese President Denis Sassou-Nguesso for gains in the national AIDS response and called for shared responsibility to close remaining gaps.

“You were a pioneer in bringing the universal access debate high on the global agenda by launching the Brazzaville Declaration, taking it to the United Nations General Assembly in 2006, and then translating it into the 2011 Political Declaration on AIDS,” said Mr Sidibé, in his meeting with the President. “Now, I encourage you to be among the key global leaders to push the concept of shared responsibility.”

In recent years, Congo has significantly increased national expenditures on AIDS. By 2011, about 50% of national HIV investments were funded through domestic sources. Mr Sidibé called on Congo’s leadership to continue reducing the country’s dependency on foreign aid while noting that international donors must also honor their funding commitments.

President Sassou-Nguesso noted that addressing gaps in Africa’s HIV response would require greater political will across the continent. He added that joint action is also critical: “We need to coordinate our efforts if we want to succeed.”

Progress

During his meeting with the President, Mr Sidibé noted the 22% national decline in the number of new HIV infections between 2003 and 2009. He commended the leadership of Congo for expanding access to HIV treatment: By 2011, more than 16 000 people in Congo were receiving HIV treatment (44% coverage).

Challenges

According to government estimates, only 14% of Congolese children eligible for HIV treatment are receiving it. Coverage of services that prevent new HIV infections among children is low, at 32%. Mr Sidibé urged the President to boost national efforts to eliminate of mother-to-child transmission of HIV, and to ensure HIV treatment access for all.

(From left to right): Maya Harper, UNAIDS Country Coordinator for Kenya; and the Champions for an HIV-Free Generation: Prof Miriam Were, Benjamin Mkapa, Festus Mogae and Dr Kenneth Kaunda, with Mr Andrew Mondo, Permanent Secretary, Ministry of State for Special Programmes, upon receiving Kenyan gifts of spears and shields as warriors in the AIDS response.

Kenya’s government, under the leadership of President Mwai Kibaki, has allocated additional funding to its national AIDS response. The announcement came last Friday during a high level advocacy meeting in Nairobi with four members of the non-profit organization Champions for an HIV-Free Generation: Festus Mogae of Botswana, Dr Kenneth Kaunda of Zambia, Benjamin Mkapa of Tanzania—all former African presidents—and Prof Miriam Were of Kenya, former chairperson of Kenya’s National AIDS Control Council.

President Kibaki stressed in the meeting that despite a scarcity of resources in Kenya, the Government will not waver in its commitment to the national AIDS response. “We are committed to ensuring that the fight against HIV and AIDS goes on uninterrupted,” said the Kenyan President.  More than 85% of resources for Kenya’s response to HIV currently come from development partners.

The Champions lauded Kenya for the progress made in its HIV programmes.  They commended the Government, specifically, for its efforts to prevent mother-to-child transmission (PMTCT) of HIV, roll out extensive voluntary medical male circumcision services, and rapidly increase HIV counselling and testing services. The Champions also praised Kenya’s leaders for their strong multi-sectoral approach in responding to the epidemic.

According to the Kenya Demographic and Health Survey (KDHS 2008/9), national HIV prevalence dropped from 7.1% in 2007 to 6.3% in 2010. Access to life- saving treatment has also improved considerably: By December 2011, over 500 000 people living with HIV in Kenya had been placed on antiretroviral therapy (representing 72% coverage)—up from just 3000 people in 2001.

During their advocacy visit, the Champions held discussions with the Cabinet sub-Committee on HIV under the authority of the Prime Minister of Kenya, Raila Odinga, as well as the Parliamentary Health Committee on Health. They advocated for the elimination of new HIV infections among children and lobbied for greater domestic resources for the AIDS response.

The Champions had an opportunity to interact with representatives from networks of people living with HIV, faith-based organizations, men who have sex with men, sex workers and the private sector. They also participated in a field visit to a community-based programme in Kibera—the largest temporary settlement in Eastern Africa—where the role of civil society in promoting and increasing demand for HIV services was emphasized.

At the end of the three-day visit, the Champions congratulated the country for its Rapid Response Initiative—a home-grown, innovative approach used to increase HIV counselling and testing levels, medical male circumcision rates and uptake of PMTCT services. They considered the initiative a “best practice” that should be replicated in other sub-Saharan Africa countries.

Cautioning against complacency in the AIDS response, the Champions called on the Kenya’s leaders to step up efforts to address the epidemic to ensure that it does not undermine national economic growth.

UNAIDS Executive Director Michel Sidibé (left) and Chinese Vice-Premier Li Keqiang. Beijing, China. 26 June 2012.
Credit: UNAIDS

UNAIDS Executive Director Michel Sidibé met with Chinese Vice-Premier Li Keqiang in Beijing as part of a two-day official visit to the country. Mr Sidibé acknowledged the significant progress achieved by the Chinese government since his last visit in December 2011 and highlighted the importance of sustained commitment to the AIDS response during, and following China’s upcoming leadership transition.

During his visit, Mr Sidibé also met with Chinese Minister of Health, Dr Chen Zhu, and presented a UNAIDS “Leaders and Innovators Award” to the President of Xinhua News Agency, Mr Li Congjun, at a ceremony in China’s Great Hall of the People.

Speaking to Vice-Premier Li, Mr Sidibé commended the Chinese government for its bold leadership over the past decade, which has led to major investments in China’s AIDS response and a dramatic scale-up of HIV prevention, treatment and care programmes in China. As Chair of China’s State Council AIDS Working Committee, Vice-Premier Li has been instrumental in providing strong leadership in China’s AIDS response in recent years.

According to Mr Sidibé, sustaining political commitment will be critical as China prepares to undergo a leadership transition in late 2012. “There is a sea-change in the AIDS response in China. This is being driven by personal leadership,” said Mr Sidibé.

China has also launched a new Five Year Action Plan on AIDS Prevention and Control, setting out ambitious targets, and has committed to fully funding its AIDS response following the withdrawal of major international donors. Uptake of voluntary HIV testing and counselling has increased rapidly. Last year, more than 80 million people received an HIV test in China, and more than 130 000 are now receiving lifesaving antiretroviral treatment, free of charge. 

Mr Sidibé stressed the importance of improving coverage of services amongst key affected populations such as men who have sex with men, sex workers and people who inject drugs. He congratulated China on its progress made scaling up access to antiretroviral medicines, and encouraged further efforts in this area. “China is leading the way on Treatment as Prevention,” said Mr Sidibé. “Continuing to explore effective approaches and models in this area will be essential for success.”

Vice-Premier Li reiterated China’s continued commitment to HIV prevention and said China stands ready for closer cooperation with UNAIDS. He said that China will deliver on its 2015 AIDS promises and that it will do whatever it can to provide medical support and medicines for AIDS.

Following China’s successful hosting of the 3^rd China-Africa Roundtable on Health earlier this month, Mr Sidibé encouraged China to continue to expand its role in facilitating south-south cooperation, particularly inAfrica. “I am calling on Africa and China to explore a new paradigm for sustaining the AIDS response through increased shared responsibility and by looking at transfer of technology and knowledge and building capacity for life-saving medicine,” said Mr Sidibé. He reiterated UNAIDS’ continuing support for China’s efforts to expand its role in international cooperation and emphasised the role China can play in supporting production of ARV drugs in Africa, reducing the continent’s reliance on imports.

The process of developing realistic and adaptable NSPs needs to keep pace with an evolving epidemic and a changing environment.
Credit: UNAIDS

A high quality, rigorous and robust National AIDS Strategic Plan (NSP) that focuses attention on achieving results—including stopping HIV transmission and extending the quality of life of people with HIV—is critical to the success of every national HIV response. The process of developing realistic and adaptable NSPs needs to keep pace with an evolving epidemic and a changing environment.

In Nairobi this week, the World Bank in collaboration with UNAIDS, WHO, UNDP and the Global Fund brought together representatives of National authorities, civil society organisations including people living with HIV and development partners to build consensus on the role and nature of the next generation of National Strategic Plans (so called NSP-3G). 

Opening the meeting, the Kenyan Minister of State for Special Programmes, Honourable Esther Murugui, stressed the importance of reviewing National Strategic Plans as a critical means for refining the AIDS response. “As a Government, we recognize the need to develop and adopt systems and structures that match the complexities of the HIV epidemic,” said Minister Murugui. “We have reached a point where we have to change the way we have always done things to a way that focuses on results,” she added.

With a new landscape requiring innovative thinking and approaches, participants explored how new guidance, based on experiences in strategic planning thus far, can support countries in producing simpler, sharper, more effective NSPs that focus on results.

The Representative of the Office of the U.S. Global AIDS Coordinator for PEPFAR, Dr Mamadi Yilla said that “PEPFAR’s hope is that science and evidence drives the approach we take to strategic planning. That the Global AIDS community, that has witnessed constraints to HIV financing commitments, now ensures smarter investments are made.”

Speaking on behalf of the UNAIDS Executive Director, Dr Mbulawa Mugabe pointed out that the Strategic Plans should provide clarity on how to achieve results in line with the 2011 Political Declaration on AIDS goals and commitments. “In the coming years we need to be able to say that progress by 2015 and beyond was underpinned by the NSP-3G,” said Dr Mugabe. “The NSP-3G is the engine that will help countries focus, scale up and reach the 2011 Political Declaration on AIDS targets as well as the commitments made towards the elimination of new HIV infections among children,” he added.

Several key components of NSP-3G emerged during the meeting. This included a move towards a more flexible, adaptive approach to plans that could see HIV programmes integrated into wider health and development strategies. Such a move links closely with the way forward charted at the Fourth High Level Forum on Aid Effectiveness in Busan, Korea in 2011. “We recognise the importance of aligning NSPs more closely to national development planning process; NSPs need to consider decentralisation issues and they should not sit outside of national mechanisms,” explained Mr Daniel Marguari, Director of the Spirita Foundation—an organisation working to improve the quality of life of people living with HIV and their families in Indonesia. “At the same time, we do not want to loose the uniqueness, inclusiveness, partnership and multisectorality of the HIV response, especially when it comes to addressing the needs of key affected populations and communities.”

Participants discussed in detail how real and sustainable country ownership of an effective, multi-sectoral response, with nationally driven strategic plans, can be better achieved. Many national responses in low-and middle-income countries need strengthening. They are often influenced by external development agendas and are still largely funded by international donors. For example in sub-Saharan Africa two-thirds of AIDS expenditures come from external sources. 

In order to sustain the HIV response, countries need to make better use of evidence to guide where to invest precious financial and human resources to achieve the HIV targets. Participants explored how countries could mobilize additional funding to meet the financing gap, while increasing efficiencies in the face of declining resources. The UNAIDS Investment Framework was described as a radical and innovative way of looking at resource allocation and closing the funding gap. It sets out to match need with investment, streamlines current strategies to avoid duplication and promotes cost-effectiveness. It supports countries to focus on investment choices that produce results for people.

“Now that our understanding of the HIV epidemic is more scientific and evidence-based, we find ourselves at a stage where we could determine what the exact sets of interventions need to be in a given response to control the epidemic,” Mr Aeneas Chuma, the UN Resident and Humanitarian Coordinator for Kenya said. “This means we need to ask if our investment is directed to the right interventions to achieve the right results.’’

The main outcome of the meeting was the development of ten consensus points on NSP-3G. A support and review group has been established to develop, finalize and disseminate new guidance to countries by October 2012. ‘‘I take note that the current national strategic plan for Kenya comes to an end next year,” said Minister Murugui. “Kenya hereby pledges to lead the world by being the first country to develop a third generation National Strategic Plan that will be based on the guidance that will come out of this important meeting.”

UNAIDS and PEPFAR bring together Health Ministers and partners from countries with the highest numbers of new HIV infections in children to scale up progress.
Credit: UNAIDS/A.Obeid

Ministers of Health and representatives from the 22* countries with the most new HIV infections in children have come together to report on progress towards achieving zero new HIV infections in children by 2015 and find ways of stepping up action.

In 2010, an estimated 390 000 children were born with HIV. However, with access to comprehensive HIV services the risk of transmission can be reduced to below 5%. In response to this, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) convened partners to develop a global plan to stop new HIV infections among children by 2015 and keep their mothers alive. The plan focuses on the 22 countries in which 90% of new HIV infections in children occur, 21 of which are in sub-Saharan Africa.

“By uniting our forces across boundaries, institutions and communities, we will leverage this historic opportunity to welcome the first generation born free of HIV by 2015,” said UNAIDS Executive Director, Michel Sidibé. “By building bridges between the movements of AIDS, maternal and child health and women’s movements, we will quicken the pace of this race towards zero.”

Since the launch of the Global Plan at the 2011 High Level Meeting on AIDS, great strides have been made in reducing HIV infections among women of reproductive age and expanding access to antiretroviral therapy for pregnant women living with HIV. However, progress is not being scaled up as quickly on meeting the family planning needs of women living with HIV, preventing maternal mortality and ensuring that all children living with HIV have access to antiretroviral therapy. All of which are key elements in the global plan to achieve zero new HIV infections in children.

“We have the knowledge and the tools to ensure that all children are born HIV-free and that their mothers are healthy,” said United States Global AIDS Coordinator Ambassador Eric Goosby. “Countries are at the forefront of efforts to achieve this vision, and as partners, we are firmly committed to their success.”

During her welcoming remarks, the Director General of the World Health Organization, Margaret Chan emphasized the full commitment of her organization towards the success of the Global Plan. “This is an ambitious, noble and achievable cause,” said Dr Chan. “It is also a great opportunity to make progress towards the integration of health services in countries.”

The President of the 65^th World Health Assembly emphasized the need to raise awareness among communities to ensure that both men and women have access to HIV services for their own health and to prevent HIV infections in children. “Women still face stigma and discrimination when found HIV positive,” said the Health Minister from Côte d’Ivoire, Thérèse N’Dri-Yoman. “Women will not disclose their status and therefore won’t access HIV services unless communities provide them with the support they need.”

Ministers shared their ideas and experiences on four focus areas related to the implementation of the Global Plan: Financing and political ownership; quality of care; community engagement; and human resources.

Speaking about innovative methods of funding, Zimbabwe’s ‘AIDS Levy’ was praised as an example of a sustainable national initiative to mobilize resources for the AIDS response. “Even though no one likes to pay taxes, people are recognizing the utility of the AIDS Levy given the results achieved in the AIDS response,” said Zimbabwean Minister of Health and Child Welfare, Henry Madzorera.

Namibia’s Minister of Health and Social Services, Richard Kamwi, also explained how his country is rapidly increasing its domestic contribution to the overall resources allocated to the AIDS response.   

The integration of services to provide better quality of care for women was also stressed as a key element by several countries. In Tanzania, for example, the Minister of Health and Social Welfare, Hussein Mwinyi, reported that currently all family planning services integrate HIV services and vice versa. Similarly, the Government of Ghana has issued a policy to provide free family planning to all. Botswana, one of the most advanced countries in preventing mother-to-child transmission of HIV, has integrated HIV services in all health settings providing antenatal care to pregnant women. “We are doing everything possible to bring health to people,” said Botswana’s Minister of Health John Seakgosing.

Countries like Burundi, Chad and the Democratic Republic of Congo reported efforts to increase the capacity of health care providers with initiatives such as nurse-driven antiretroviral treatment programmes, expanding service delivery outlets and promoting decentralization.

The importance of community engagement in implementing the Global Plan in countries was stressed by Lucy Ghati from the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK). “Communities are critical if prevention of mother-to-child services are to be scaled up,” said Ms Ghati. “Women living with HIV must be represented on local and national committees to determine what their needs are as well as to ensure ownership of the response.” Similarly, France’s AIDS Ambassador Mireille Guigaz said, “Every time we look at the problems of women and children we have to get as close as possible to communities. If we don’t give them the opportunity to express how they feel and take their experiences into account, we won’t be able to provide a successful response to AIDS.”

The Deputy General Manager of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Debrework Zewdie, noted that 15% of the funding for HIV prevention goes to the elimination of new HIV infections among children. However, she highlighted that the Global Fund is demand-driven and that countries must request the funds.

Sweden’s AIDS Ambassador Anders Nordström emphasized his country’s commitment to preventing new HIV infections among children and said that Sweden would be allocating US$ 15 million to support Global Plan efforts.

Business Leadership Council for a Generation Born HIV-Free CEO John Megrue reinforced the commitment of the private sector to eliminate new HIV infections among children and keep their mothers alive. He highlighted that the organization will focus its efforts on mobilizing resources among the private sector, advocating for other companies to join the council and to helping countries to accelerate implementation of the Global Plan.

The meeting was the first annual face-to-face gathering of representatives from the 22 focus countries since the launch of the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive in 2011.

*The 22 priority countries are: Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia and Zimbabwe.