UNAIDS has relaunched its Key Populations Atlas. The online tool that provides a range of information about members of key populations worldwide—sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people and prisoners—now includes new and updated information in a number of areas. And in addition to data on the five key populations, there are now data on people living with HIV.

Chief among the new data is information on punitive laws, such as denial of the registration of nongovernmental organizations, and on laws that recognize the rights of transgender people. The overhaul of the site was undertaken in consultation with representatives of civil society organizations, including the International Lesbian, Gay, Bisexual, Trans and Intersex Association, which supplied some of the new data on punitive laws.

Data on the number of users of Hornet—a gay social network—in various countries has been made available for the atlas by the developers of Hornet, while Harm Reduction International supplied information on the availability of harm reduction programmes in prisons.

“Having data on the people who are the most affected by HIV is vital to getting the right HIV services available at the right locations” said Michel Sidibé, the Executive Director of UNAIDS. “The Key Populations Atlas allows UNAIDS to share the information we have for the most impact.”

The Key Populations Atlas is a visualization tool that allows users to navigate country-specific subnational data on populations particularly vulnerable to HIV. Data are presented on, for example, HIV prevalence among people who inject drugs in 11 sites in Myanmar, key populations sizes, antiretroviral therapy coverage among gay men and other men who have sex with men in 13 sites in India and specific prevention services and preventive behaviours. Updated data on many indicators that were obtained through the Global AIDS Monitoring exercise undertaken in 2017 is now available on the website.

Over the coming weeks, information on people living with HIV will be expanded, with new indicators being added, and data from the 2018 Global AIDS Monitoring will be added when available later in the year.

The continued existence of compulsory drug detention and rehabilitation centres across Asia remains a serious concern. People who are suspected of using drugs or being dependent on drugs, people who have engaged in sex work or children who have been victims of sexual exploitation are often detained in these centres without due process in the name of treatment or rehabilitation.

There are serious human rights issues concerned with compulsory drug detention and rehabilitation centres and they threaten the health of the detainees, including through increased vulnerability to HIV and tuberculosis infection.

Physical and sexual violence, forced labour, substandard conditions, denial of health care and other forms of human rights violations have been documented in many centres. Although reported in many parts of the world, compulsory drug detention and rehabilitation centres are most prevalent in Asia. According to official accounts reported in 2012, more than 235 000 people were detained in over 1000 compulsory drug detention centres in East and South-East Asia.

HIV prevalence among people who inject drugs is estimated to be 28 times higher than among the general population. Stigma, discrimination and punitive laws greatly contribute to the high HIV prevalence among people who use drugs and prevent the provision of evidence-informed drug dependence treatment and HIV services.

In a 2012 joint statement on drug detention and rehabilitation centres, 12 United Nations entities noted that there is “no evidence that these centres represent a favourable or effective environment for the treatment of drug dependence.” The statement further calls on those states that maintain these centres to close them without delay, to release the people detained and to provide appropriate voluntary health care and drug dependence treatment for people in need, at the community level.

There has been coordinated and concerted action by the United Nations system at the country, regional and global levels to engage governments on the issue. These efforts have supported a series of intergovernmental dialogues in Asia that have promoted emerging best practices in implementing evidence-informed and rights-based drug dependence treatment.

However, progress at the country level has remained largely insufficient. Some countries in the region have recently been reported to be planning to increase the capacity of their drug detention centres, or to consider legislation to further entrench them.

During a recent visit to Asia, UNAIDS Executive Director Michel Sidibé called for accelerating reform towards voluntary and community-based drug treatment programmes as a human rights and public health imperative. “Now is the time for pragmatism and evidence. Countries must expand rights-based policies and programmes that work in addressing drug dependence and vulnerability to HIV,” said Mr Sidibé.

The urgent need to expand evidence-informed and rights-based drug dependence treatment in Asia is clear and needs to be a central part of upcoming discussions on drug policy and health, such as the third intergovernmental dialogue on compulsory drug detention centres in Asia in 2015 and concrete advances made ahead of the 2016 United Nations General Assembly Special Session on Drugs.

At its 35th meeting, in December 2014, the UNAIDS Programme Coordinating Board will hold a series of discussions on reducing HIV transmission among people who inject drugs as a critical component of efforts to end the AIDS epidemic by 2030.

UNAIDS Executive Director, Michel Sidibé met with Indonesia’s Minister of Health, Nafsiah Mboi as part of his two-day trip to Indonesia.
Credit: UNAIDS/E.Wray

Indonesia’s Minister of Health, Nafsiah Mboi, pledged to scale up HIV testing and treatment programmes, leading to zero new HIV infections and zero AIDS-related deaths. Minister Mboi met with UNAIDS Executive Director, Michel Sidibé on Tuesday, on the first day of his two-day trip to Indonesia.

Indonesia is one of several countries in Asia where new HIV infections are growing. The Ministry of Health estimates that more than 600 000 people are living with HIV and that there are more than 76 000 new HIV infections each year. Currently HIV treatment coverage is at less than 20%.

But, Minister Mboi promised a new approach to the country’s AIDS response. She said she will ensure that everyone will know their HIV status and have access to HIV treatment. Health authorities will focus on 141 districts where key affected populations are the highest. Indonesia’s epidemic is concentrated on key populations at higher risk such as drug users, sex workers and their clients and men who have sex with men.

Indonesia is taking an active role in the AIDS response in Asia. As chair of the last year’s ASEAN (Association of South East Asian Nations) summit the country pushed for the adoption of the ASEAN Declaration of Commitment in Getting to Zero New HIV Infections, Zero Discrimination and Zero AIDS-related deaths.

Indonesia also plans to become one of several countries in the region to offer universal health care by 2014. The Ministry of Health says that HIV treatment will be included in the health coverage.

“Indonesia is a key partner in the drive to end the AIDS epidemic,” said Mr Sidibé. “Universal health coverage is a game changer for Indonesia. I am delighted to know that HIV treatment will be included in this national programme. This sets the stage for sustainable funding of HIV programmes.”

UNAIDS Executive Director, Michel Sidibé toured the Narcotics Prison Cipinang in East Jakarta where he met with prison authorities and visited the clinic where antiretroviral treatment and methadone services are provided.
Credit: UNAIDS/E.Wray

Domestic investments in the HIV response have been increasing significantly in Indonesia since 2010, but there still is a large funding gap and in 2015 Indonesia will no longer be eligible for funding from the Global Fund to Fight AIDS, Malaria and Tuberculosis.

“Indonesia is trying to ensure the sustainability of HIV care for people living with HIV once donor countries stop giving funds,” said Minister Mboi. “The Ministry of Health is preparing an exit strategy. We plan to cover 100% of the HIV treatment by the national government budget,” she added.

Health authorities are increasing efforts to focus HIV programmes on communities that need the most attention. The sharing of needles among people who use drugs has been one of the drivers of the HIV epidemic in Indonesia. Since 2009, the Directorate General of Corrections says it has scaled up its HIV programmes at 149 corrections facilities in 25 provinces.

Mr Sidibé toured the Narcotics Prison Cipinang in East Jakarta, which is one of eleven model prisons implementing a comprehensive AIDS programme. He met with prison authorities and then went on a tour of the prison, visiting the clinic where antiretroviral treatment and methadone services are provided. He also toured the occupational training centre where inmates learn new skills including baking, sewing and handicrafts. 

“My visit today shows that even in prisons we can restore the dignity of people,” said Mr Sidibé. “Prison can be a transformative experience. The Indonesian government is showing great innovation and courage with its remarkable harm reduction and HIV programme in prisons. I hope the programme inspires other countries to show the same entrepreneurship,” he added.

The Ministry of Health hosted a dialogue between Mr Sidibé and faith based organizations, including Islamic, Christian, Hindu, Buddhist and Confucian religious groups.
Credit: UNAIDS/E.Wray

On Tuesday, the Ministry of Health hosted a dialogue between Mr Sidibé and faith based organizations, including Islamic, Christian, Hindu, Buddhist and Confucian religious groups. Religious leaders are important community members and their cooperation is key to ensuring support for HIV prevention, treatment and care.  The leaders agreed that faith based organizations need more education and training in HIV issues, so that they can help their communities.

Anggia Ermarini, Health Unit Secretary of Indonesia’s Ulama Council, the country’s Muslim clerical body said, “Many religious leaders do not understand about AIDS. We want the United Nationsto to tell us about the situation in our country.”

Franz Magnis Suseno, a Jesuit priest from the Institute of Philosophy Driyakara said that he thought that religious organizations needed to start to educate people about sexuality. He said there was a high resistance to sex education but that it was necessary.

Mr Sidibé is in Indonesia at the start of a three country trip to Asia, where he will also visit Myanmar and Thailand.

Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe

Mounting an effective challenge to HIV in prison settings is a key part of the AIDS response at national, regional and global levels. To define standards for HIV prevention and treatment and the protection and promotion of prisoners’ human rights, it is important to consolidate as much data as possible about the epidemic in this environment. The newly established Monitoring Centre for HIV and Prisons in Latin America and the Caribbean is set to become the key regional repository for such vital information. 

The Monitoring Centre—called the Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe in Spanish—gathers data from 23 countries which is accessible via a web site. Its primary aim is to help governments and civil society define and implement national HIV prison policies based on international standards. Up and running in Spanish since mid-February, an English language version will be launched 30 April 2011.

The United Nations Office on Drugs and Crime (UNODC) is spearheading the initiative with support from the UN Educational, Scientific and Cultural Organisation (UNESCO), the Pan American Health Organization (PAHO), the World Bank, the UN Development Programme (UNDP) and UNAIDS.

According to José Vila del Castillo, UNODC Regional Advisor, “The Monitoring Centre shows the United Nations system ‘delivering as one’. Addressing HIV in the region’s prisons has become a priority. The centre is an important tool to catalyze prison reform processes and HIV penitentiary programmes.” 

Providing a permanent public space for informed reflection and dialogue, the virtual centre develops methodologies for collecting, processing, analysing and validating the scientific data gleaned on what works, and how best to proceed, in addressing HIV in prisons. It will highlight existing information and encourage ongoing research. Training and technical support are also offered through reference directories, online consultations, discussion forums and virtual classrooms.

In Latin America and the Caribbean, as elsewhere, many prisoners are vulnerable to HIV due to a number of factors, including the relative lack of knowledge about the virus among this population, overcrowding, lack of access to protection and good quality health services and violent conditions.

Across the region, where data are available, several countries have higher HIV prevalence in the prison population than in the general population. For example, according to data collected by UNODC this year, in Peru there are more than eight times as many people living with HIV in prison than outside (4.03% versus 0.4%). In Bolivia the situation is even starker; the same source documents show that in nine prisons in the country, 10% of prisoners are reported as HIV positive, compared to 0.2% prevalence in the wider society. 

César Antonio Núñez, Director of UNAIDS’ Latin America Regional Support Team, believes the Monitoring Centre will provide a valuable insight into the lives of a neglected population, “The Centre will really help us to know the true HIV situation in the penitentiary system, and shed light on human rights-related issues. It is probably in the environment of HIV and prisons where UNAIDS’ commitment to being ‘the voice of the voiceless’ is most needed and appropriate.”

ICPA Executive Director, Mr. Ed Wozniak presenting the award to Dr Fabienne Hariga, Senior Expert, HIV/AIDS Section at UNODC who accepted the award on behalf of the network.

The African HIV in Prisons Partnership Network (AHPPN) has been presented with the prestigious 2010 Healthcare Award by the International Corrections and Prisons Association (ICPA).The award was given during the Association's Annual Conference which took place in Ghent, Belgium from 24 - 29 October.

The Executive Director of ICPA, Mr Ed Wozniak, noted that the award was given in light of the “remarkable and innovative work in the area of HIV of the African HIV in Prisons Partnership Network (AHPPN)”.   

The AHPPN is an initiative of the United Nations Office on Drugs and Crime (UNODC). It was created to support governments in their efforts to mount an effective, human rights-based response to HIV and TB in prisons in Africa, and to offer a platform for national, international and multi-sectoral cooperation and action.

According to a 2007 UNODC report existing data suggest high HIV prevalence rates among African prisoners as compared to the general adult population. A study cited in the report indicated HIV prevalence as high as 40% among prisoners in some prisons in South Africa. (The study was conducted in a limited number of prisons and not considered representative of the entire prison population in South Africa.).

Formally launched in November 2009 by UNODC, in partnership with the World Health Organization, the World Bank and UNAIDS, the work of the AHPPN is guided by the belief that ‘good prison health is good public health’.

The network’s efforts include a new website, and has built a comprehensive data collection questionnaire to gather up-to-date and reliable primary source data on HIV in prison settings.

Accepting the ICPA Healthcare Award on behalf of the AHPPN was Dr Fabienne Hariga, Senior Expert, HIV/AIDS Section at UNODC and AHPPN Steering Committee member and Zambian Commissioner of Prisons, Mr Percy Chato.

Michel Sidibé meets with H.E. Mohammad Reza Rahimi, First Vice President of the Islamic Republic of Iran. Credit: UNAIDS

In nearly all countries, HIV prevalence among prisoners is significantly higher than in general population. A variety of factors contribute to the spread of HIV in prison settings, including unsafe injecting drug use, unprotected sex, tattooing with contaminated equipment and poor prison health services.

In the Islamic Republic of Iran, HIV prevalence among prisoners is about eight times higher than in the general population. Injecting drug use is the main mode of HIV transmission, accounting for more than 70% of reported HIV cases in Iran.

A visit this week to Iran by UNAIDS Executive Director Michel Sidibé highlighted the country’s progressive work in addressing its HIV epidemic in prisons and among people who inject drugs. Iran’s 250 prisons, rehabilitation camps and juvenile correctional centers house approximately 180 000 inmates. Nearly half of all inmates are imprisoned on drug-related charges.

“What I saw in Qezel Hessar Prison is an evidence-based approach marked by tolerance, pragmatism and compassion,” said Mr Sidibé after touring the largest detention center in the region.  “I am impressed with the comprehensive package of HIV prevention, treatment, care and psychosocial support that the prison provides.”

Located near Karaj City, the Qezel Hessar Prison has 19 000 inmates, the majority incarcerated on drug-related offences. The facility offers a wide range of HIV-related services, including opioid substitution therapy, antiretroviral therapy, voluntary testing and counselling, access to condoms and sterile razors, psychotherapy and other behavioral interventions.

Qezel Hessar Prison provides methadone maintenance therapy to more than 2700 inmates on a daily basis, a 30-fold increase since 2003. Like most other prisons in country, married prisoners are allowed conjugal visits with their spouses and are provided with private rooms and condoms.

Executive Director meets senior Iranian officials and people living with HIV

Michel Sidibé meets with a group of HIV-positive people at the "Positive Club" in the Iranian Research Center for HIV and AIDS. Credit: UNAIDS

In meetings with First Vice President Mohammad-Reza Rahimi and other top Iranian officials, Mr Sidibé urged authorities to work towards the goals of “zero new HIV infections among drug users” and “zero newborns with HIV.” Iranian authorities expressed the commitment of the Islamic Republic of Iran to address the HIV epidemic based on the Islamic concept, “If you save one life, you are saving humanity.”

As part of his official mission, Mr Sidibé also visited a “Positive Club” located in the Iranian Research Center on HIV and AIDS. Addressing a group of people living with HIV, he said: “When I hear the words “hope,” “happiness” and “job,” I feel that our efforts have not been wasted.”

During the visit, Mr Sidibé emphasized the work of Iranian health authorities in helping restore the lives and dignity of people living with HIV through the establishment of such Positive Clubs and the provision of information, antiretroviral medicines and other HIV-related services.

Speaking on behalf of people living with HIV, the head of the Positive Club’s council told Mr Sidibé that AIDS is a very difficult area to address. “It requires courage and patience, and you are one of those people who have the courage and patience to work in this area,” he said. “We are happy to have your support, and we are ready to work with you together.”