Focus on Women and Girls Key to MDG Success. 21/9/10

The importance of pursuing this strategy is evidenced by innovative programs that are addressing the multiple needs of women and girls

AllAfrica

As world leaders gather this week in New York to assess progress on the Millennium Development Goals (MDGs), they will face stark challenges to social and economic development, given ongoing wars and the global economic recession.

Yet the MDGs also provide an opportunity – to focus on ensuring basic rights and access to health services for women and girls as the path to achieve the MDG goals. The administration of U.S. President Barack Obama, which has made women and girls a cornerstone of its Global Health Initiative, should seize the opportunity to turn these enlightened MDG goals into effective policies and programs, by making global health, development and gender interlinked components of foreign policy.

Last year, the United States government launched its Global Health Initiative and initiated the second phase of the President’s Emergency Plan for AIDS Relief (Pepfar). These programs are being rolled out against the backdrop of the Obama administration’s high-level commitment to advance a women- and girls-centered approach.

The challenge now is to maximize the opportunities and tackle the challenges in pursuing policies and programs to link HIV/Aids initiatives with other health and development areas that particularly affect women and girls, including education for girls, economic empowerment for women and reproductive health. It is clear that considerable innovation is taking place in these areas in some of the countries hardest hit by the AIDS epidemic, and that addressing these linkages is critical to meeting the needs of women and girls, and can generate concrete results.

The importance of pursuing this strategy is evidenced by innovative programs that are addressing the multiple needs of women and girls, such as the IMAGE program in South Africa.

IMAGE - Intervention with Microfinance for AIDS and Gender Equity - is a community-based intervention that started in 2001 in rural Limpopo Province that combines microfinance with a gender and HIV curriculum. IMAGE has shown that it is possible to address health and development together and to demonstrate measurable impacts in both areas, underscoring the need for future investments to support programming beyond the health sector to address women’s social and economic empowerment and their vulnerability to HIV infection.

Lina, a soft-spoken and committed outreach worker for IMAGE, explained why the approach of combining gender and health training with microfinance has been so successful in enabling women to protect themselves:

“I’ve seen a lot of changes with the women – now people are starting to talk about HIV and to talk to their children about sex and sexuality, to encourage family members to go for testing. Before I got [the IMAGE] training, I thought it was taboo to discuss these things with children.

“Microfinance is key because if you don’t bring income in the household, it’s hard to contribute to decision-making. Now we help start conversations in families – husbands and wives discuss issues…. Economic empowerment helps contribute to decision-making… Violence is going down…with training, we know how to approach the situation so we don’t escalate violence.”

After two years, the IMAGE study found that the risk of violence against women among participants was reduced by 55 percent. Among young women participating in the program, other factors related to HIV risk were also positively affected, including increased communication about HIV, a 64 percent increase in voluntary counseling and testing, and a 24 percent reduction in unprotected sex.

The study also documented positive changes in household economic wellbeing, including increased food security, expenditures and household assets, and the women maintained high loan repayment rates. The evaluation also documented improvements across a range of indicators of women’s empowerment, including increased self-confidence, autonomy, social capital, collective action and an ability to challenge gender norms.

While global attention to the importance of integrated approaches to address women’s and girls’ health is growing, many challenges remain.

In particular, the new U.S. principle of ensuring a women- and girls-centered approach will have to address the challenges inherent in programming in different health and development areas, including how to demonstrate cross-sectoral impact; how to develop a cross-sectoral approach to gender indicators and outcomes; how to replicate and scale up promising programs; how to demonstrate that linkages are key to building cost-effective and sustainable approaches; and how to create space to learn from failure, given that innovation carries certain risks.

To be successful, the U.S. government should:

In August, President Obama said: “In Africa, in particular, one thing we do know is that empowering women is going to be critical to reducing the [HIV] transmission rate.” The MDG Summit is an unprecedented opportunity to propel the United States to develop strategies and implement programs that make a difference in the lives of women and girls.

HIV Impacts MDGS on Maternal and Child Health. 7/9/10

Lack of progress on one MDG impedes progress on the other

World leaders are meeting in New York this month to review global progress to reaching the Millenium Development Goals (MDGS) by the target date of 2015. Despite some progress, it’s not looking good.

Achieving each of the health MDGs is closely dependent on the others. Unfortunately, HIV infection continues to remain a major barrier to the achievement of MDGs 4 and 5 on maternal health and child mortality in many low-income countries.

This calls for the renewed approach of using and strengthening HIV responses as an entry point to maternal and child health services. Opportunities exist to respond in a much more integrated and effective way.

Opportunities

Prevention of mother to child transmission

The prevention of mother to child transmission (PMTCT) provides a unique point of contact with a pregnant woman, a post-natal mother and a new born child and is an opportunity to deliver specific interventions that have been shown to reduce maternal and child mortality. PMTCT programs should be used to deliver or link to antenatal care, child health services, such as vaccinations, Vitamin A supplements, insecticide treated bed nets and comprehensive counselling on contraception, nutrition and breastfeeding. 

PMTCT interventions, such as those implemented by the Alliance, are critical in ensuring women do not become infected with HIV in the first instance, and if infected they can space their subsequent children through contraception (an intervention which also reduces child mortality), and access treatment, care and support for themselves, their spouses and children, whether infected or not.

VCT and sexual and reproductive health services

Indeed, women with HIV are living longer and healthier lives, and need to exercise their rights to access good quality reproductive health services. There is an urgent need to respond to the increasing number of HIV infected women who desire to get pregnant and bear children by expanding reproductive health services within PMTCT and Voluntary Counselling and Testing (VCT) programs.

Integrating VCT with family planning and vice versa is an effective strategy for expanding both services and reaching a wider range of clients. Achieving target 2 of MDG 5, which aims to ensure universal access to good quality sexual and reproductive health (SRH) services, requires commitment to explore all opportunities to integrate SRH in all health services, including HIV.

In addition, promotion of widespread condom use as a child spacing contraception would have significant reductions in child mortality. Strategies to achieve MDG 5 must use this window of opportunity to scale up coordinated and integrated services within HIV responses.  

Child health

Likewise, the provision of support for early and exclusive breastfeeding and newborn care including immunization, hygienic cord care and early newborn complications within community based HIV activities can have a positive impact on the more than 8 million child deaths annually. HIV accounted for 2.2% of these, of which 74% occurred in countries where the Alliance works.

There is clear evidence that children who lose their mothers at birth or in early childhood are at a high risk of ill-health and death. Unless the health MDGs are addressed together, there is a risk of a ‘health trap’ in which lack of progress on one impedes progress on the other.

Apart from adversely affecting progress on MDG 4 and 5, HIV also has a negative impact on the other MDGs.  Poverty impacts on peoples’ vulnerability to HIV. It increases poverty though high economic costs at both household and national levels, threatens household food security, frustrates global efforts to achieve universal basic education by reducing school attendance and increasing mortality amongst teachers, amplifies the severity and deaths due to  malaria, and remains the single most important barrier to overcoming TB.

In 36 countries worldwide, the Alliance implements programs which have a direct positive impact on maternal and child mortality within PMTCT and child focussed programs. These include: counselling on sexual reproductive health, provision of contraception and care and support to vulnerable children within the community.

For example, in Nigeria, the Alliance’s partner NELA runs a short-stay centre which provides basic primary health care services, including rapid malaria testing, treatment of opportunistic infections, referral systems for pregnant mothers to PMTCT services and supports 52 households and 3502 adults and children with nutritional counselling and commodities, implements counselling on breastfeeding, immunization and links HIV positive women to government hospitals for PMTCT services.

In Ethiopia the Strengthening Communities Response to HIV/AIDS (SCRHA) project supported by USAID and implemented by the Alliance, PATH and partners is working through urban health extension workers to deliver palliative care including nutrition, HIV counselling and testing and PMTCT services with a preventative and referral focus. The Alliance is also supporting post natal mothers by providing community-based care and support to HIV-positive women through the postpartum period, including drug prophylaxis for themselves and their newborn infants.

In order to deliver comprehensive services referrals are made for services that aren’t offered by the Alliances’ linking organizations such as antenatal care and management of labour.  This involves the use of peer educators and community health workers to provide continuity of care and link services. This way the outreach services are extended to an even greater extent to reach marginalised and hard-to reach populations.

As leaders review the progress made, those involved need to be thinking about linking interventions to address MDGs 4, 5 and 6 together, but for this to be successful it needs to be done within the broader framework of strengthened health systems, participatory community approaches and increased financial commitment from donors. Anything less may mean that we will not achieve our goals.

HIV/AIDS Hinders Millennium Development Goals. 24/2/11

Situation requires a cohesive response from the government and society in general.

Luanda — The deputy governor of Luanda for social affairs, Juvelina Imperial, said Thursday in Luanda, that HIV/AIDS currently is one of the biggest obstacles to development and is a "serious" threat to progress and achievement of the Millennium Development Goals (MDGs).

According to the official, who was speaking at the opening of the conference on partnership strategies for HIV/AIDS, the situation so requires, a cohesive response from the government and society in general.

She added that the HIV/AIDS epidemic, with profiles and different behaviours at the different provinces of the country, represents an additional challenge to efforts of promoting human development.

The conference, promoted by the Angolan Association of Journalists against HIV/AIDS, will be finished on Friday, and aims among others to strengthen the reporting mechanisms to combat this disease.

MDGs - Donors Hold Key to HIV-Free Generation. 4/1/11

Top UN health officials are confident that an HIV-free generation is possible by 2015

Top UN health officials are confident that an HIV-free generation is possible by 2015, but have warned of the need to fully fund HIV/AIDS prevention and treatment programmes to ensure that steady progress in recent years does not fall by the wayside.

"This is an unprecedented moment [of] unprecedented momentum. I urge development partners to support the Global Fund [to Fight AIDS, Tuberculosis and Malaria] in their replenishment," said World Health Organization Director-General Margaret Chan, speaking on 21 September at an event on the sidelines of the three-day Millennium Development Goals summit at the UN headquarters in New York.

Chan added that without adequate funding all the good will, positive interventions and commitments from countries would amount to little.

The importance of preventing mother-to-child transmission of HIV (PMTCT) to achieve three of the Millennium Development Goals (MDGs) - reducing child and maternal deaths, as well as halting and beginning to reverse the spread of HIV/AIDS - "cuts out the fights and competition", for funding and programming, Chan noted.

Efforts to achieve the three goals could benefit from various women's health funding and policy commitments rolled out this week during the summit to mark 10 years since countries committed to the MDGs. But HIV, the leading cause of death among reproductive-age women worldwide, could also serve as a weak link causing women's health targets to veer off track.

About 45 percent of HIV-positive pregnant women received antiretroviral (ARV) treatment to prevent HIV transmission to their children in 2008, an increase from the 35 percent that were treated in 2007.

Scaling up treatment to the 1.4 million pregnant women living with HIV who needed ARV treatment in 2009 to prevent mother-to-child transmission "can be done," Jimmy Kolker, UN Children's Fund (UNICEF) chief of HIV/AIDS, told IRIN/PlusNews before the high-level meeting. "It doesn't require any specific breakthrough or work that isn't already there."

Global Fund seeking pledges

But efforts remain partially dependent on donor countries' contributions to the Global Fund, a major contributor to PMTCT programmes. The international aid agency is seeking replenishment of US$13-20 billion for a three-year period in a "hugely challenging economic environment", according to Global Fund Executive Director Michel Kazatchkine.

France pledged $1.4 billion to the Global Fund, which provides a fifth of all financing for AIDS globally, this week; Canada later followed with its own pledge of $540 million, while Germany will provide $25 million to Côte d'Ivoire in a debt swap agreement and Norway announced that it will increase its contribution to the Global Fund by 20 percent for the next three years, making a total contribution of $225 million.

Attention is now shifting to the USA, which is being lobbied by advocacy organizations like ONE to donate $6 billion. Kazatchkine said he was expecting an announcement this week from US President Barack Obama, but although Obama spoke of strengthening the US's commitment to the Global Fund in his speech at the summit on 22 September, he did not reveal any funding pledges.

The US contributed a record-setting $1.05 billion to the Global Fund for the 2010 fiscal year, but has been criticized for not merging AIDS programming and funding laid out in the US President's Emergency Plan for AIDS Relief (PEPFAR), and in its new $63 billion Global Health Initiative with international strategies.

The Global Fund fell short by $3 billion in its last replenishment in 2007. It reached a partial goal of $10 billion to be distributed over 2008, 2009 and 2010.

"Each single dollar counts and when you cut the money short you jeopardize a few more lives," said Sipho Moyo, Africa director for ONE. "We need to continue to invest in this. Donors have to put their money where their mouth is."

Scaling up PMTCT services

High-burden countries, specifically in sub-Saharan Africa, have continued to do their part in tackling mother-to-child transmission of HIV, according to Kazatchkine, switching from sub-optimal single-dose nevirapine to "the most appropriate antiretroviral regimens".

This gradual shift has resulted in an overall increase of 65 percent in PMTCT budgets in high-burden countries.

Seventy out of 123 reporting countries revealed plans to further scale up PMTCT services in 2008, a jump from the 34 countries that presented such plans in 2005.

Namibia, which has a 15 percent rate of HIV prevalence among adults, was singled out for its success in broadening its PMTCT services since 2005. Now more than 60 percent of HIV-positive pregnant women receive ARV treatment and HIV prevalence among children under one dropped from 13.5 percent in 2006 to 7 percent in 2009, according to Namibian President Hifikepunye Lucas Pohamba.

Stigma challenges

Chan praised Pohamba for his commitment to eradicating mother-to-child transmission, maintaining the upbeat tone that characterized much of the event.

"Even just a few years ago it would have been inconceivable that a panel discussion about women living with HIV could be called a time for hope," said UNICEF's Executive Director Anthony Lake. "A few years ago, for far too many women a diagnosis of HIV meant, in effect, a double death sentence for the mother and the baby."

Yet it will take more than confidence, agreement on a common strategy to eliminate PMTCT, and adequate funding, to help HIV-positive pregnant women receive testing and treatment on a universal scale, said UNICEF's Kolker.

MDGs: Donors Hold Key to HIV-free Generation. 23/9/10

Top UN health officials are confident that an HIV-free generation is possible by 2015

New York - Top UN health officials are confident that an HIV-free generation is possible by 2015, but have warned of the need to fully fund HIV/AIDS prevention and treatment programmes to ensure that steady progress in recent years does not fall by the wayside.

“This is an unprecedented moment [of] unprecedented momentum. I urge development partners to support the Global Fund [to Fight AIDS, Tuberculosis and Malaria] in their replenishment,” said World Health Organization Director-General Margaret Chan, speaking on 21 September at an event on the sidelines of the three-day Millennium Development Goals summit at the UN headquarters in New York.

Chan added that without adequate funding all the good will, positive interventions and commitments from countries would amount to little.

The importance of preventing mother-to-child transmission of HIV (PMTCT) to achieve three of the Millennium Development Goals (MDGs) - reducing child and maternal deaths, as well as halting and beginning to reverse the spread of HIV/AIDS - “cuts out the fights and competition”, for funding and programming, Chan noted.

Efforts to achieve the three goals could benefit from various women’s health funding and policy commitments rolled out this week during the summit to mark 10 years since countries committed to the MDGs. But HIV, the leading cause of death among reproductive-age women worldwide, could also serve as a weak link causing women’s health targets to veer off track.

About 45 percent of HIV-positive pregnant women received antiretroviral (ARV) treatment to prevent HIV transmission to their children in 2008, an increase from the 35 percent that were treated in 2007.

Scaling up treatment to the 1.4 million pregnant women living with HIV who needed ARV treatment in 2009 to prevent mother-to-child transmission “can be done,” Jimmy Kolker, UN Children’s Fund (UNICEF) chief of HIV/AIDS, told IRIN/PlusNews before the high-level meeting. “It doesn’t require any specific breakthrough or work that isn’t already there.”

Global Fund seeking pledges

But efforts remain partially dependent on donor countries’ contributions to the Global Fund, a major contributor to PMTCT programmes. The international aid agency is seeking replenishment of US$13-20 billion for a three-year period in a “hugely challenging economic environment”, according to Global Fund Executive Director Michel Kazatchkine.

France pledged $1.4 billion to the Global Fund, which provides a fifth of all financing for AIDS globally, this week; Canada later followed with its own pledge of $540 million, while Germany will provide $25 million to Côte d’Ivoire in a debt swap agreement and Norway announced that it will increase its contribution to the Global Fund by 20 percent for the next three years, making a total contribution of $225 million.

Attention is now shifting to the USA, which is being lobbied by advocacy organizations like ONE to donate $6 billion. Kazatchkine said he was expecting an announcement this week from US President Barack Obama, but although Obama spoke of strengthening the US’s commitment to the Global Fund in his speech at the summit on 22 September, he did not reveal any funding pledges.

The US contributed a record-setting $1.05 billion to the Global Fund for the 2010 fiscal year, but has been criticized for not merging AIDS programming and funding laid out in the US President's Emergency Plan for AIDS Relief (PEPFAR), and in its new $63 billion Global Health Initiative with international strategies.

The Global Fund fell short by $3 billion in its last replenishment in 2007. It reached a partial goal of $10 billion to be distributed over 2008, 2009 and 2010.

“Each single dollar counts and when you cut the money short you jeopardize a few more lives,” said Sophio Moyo, Africa director for ONE. “We need to continue to invest in this. Donors have to put their money where their mouth is.”

Scaling up PMTCT services

High-burden countries, specifically in sub-Saharan Africa, have continued to do their part in tackling mother-to-child transmission of HIV, according to Kazatchkine, switching from sub-optimal single-dose nevirapine to “the most appropriate antiretroviral regimens”.

This gradual shift has resulted in an overall increase of 65 percent in PMTCT budgets in high-burden countries.

Seventy out of 123 reporting countries revealed plans to further scale up PMTCT services in 2008, a jump from the 34 countries that presented such plans in 2005.

Namibia, which has a 15 percent rate of HIV prevalence among adults, was singled out for its success in broadening its PMTCT services since 2005. Now more than 60 percent of HIV-positive pregnant women receive ARV treatment and HIV prevalence among children under one dropped from 13.5 percent in 2006 to 7 percent in 2009, according to Namibian President Hifikepunye Lucas Pohamba.

Stigma challenges

Chan praised Pohamba for his commitment to eradicating mother-to-child transmission, maintaining the upbeat tone that characterized much of the event.

“Even just a few years ago it would have been inconceivable that a panel discussion about women living with HIV could be called a time for hope,” said UNICEF’s Executive Director Anthony Lake. “A few years ago, for far too many women a diagnosis of HIV meant, in effect, a double death sentence for the mother and the baby.”

Yet it will take more than confidence, agreement on a common strategy to eliminate PMTCT, and adequate funding, to help HIV-positive pregnant women receive testing and treatment on a universal scale, said UNICEF’s Kolker.

“In every context there are challenges of stigma so mothers are not tested, or don’t come back for the results,” Kolker explained. “Or they take the medicines home but they don’t take them as instructed. Many things must change in attitude and behaviour to make services readily available.”

In 2008, only 5 percent of pregnant women in low- and middle-income countries reported that their male partners were tested for HIV. Kolker said engaging fathers is “absolutely crucial” in making services more widespread and dispelling notions about women having “low moral character” and bringing the infection into their relationships.

Millennium Development Goals Count-Down. Living with AIDS # 439. 15/7/10

Two-thirds of the deadline has already passed

Health-e

In 2000, the world’s leaders committed themselves to the United Nations’ Millennium Development Goals to make our planet a healthier place to live in by the year 2015. Two-thirds of the deadline has already passed. Is the world succeeding in its commitments, for instance, to combat HIV/AIDS, malaria and other diseases which are endemic in countries such as South Africa?

“HIV and AIDS, TB and Malaria do affect women and children more than any sector and is wreaking havoc on the lives of our mothers and children”, Motsoaledi said.

“The Millennium Development Goal # 5 seeks to reduce by three-quarters the maternal mortality ratio by 2015. We, in South Africa have not given up hope, and instead, we are preparing to move up to the highest gear to ensure that we do achieve this goal by 2015. We are actually re-focusing all our departmental programmes to be centred around the Maternal, Child and Women’s Health Unit. We are putting up plans for strengthening this unit because the health of mothers and children directly affects the future and the development programme of the nation”, he continued.

The Health Department’s own National Committee on Confidential Enquiry into Maternal Health, which seeks to identify what causes maternal deaths, shows that an overwhelming majority of maternal deaths is due to HIV and AIDS.  

“It was found that while 54% of these deaths are due to a variety of causes – many of them, of course, preventable – a whopping 46% alone is due to HIV and AIDS”, said Motsoaledi.

Another Health Department report, “Saving Babies”, confirms that, just like their mothers, babies and children also succumb to HIV and AIDS. This has implications for the country’s ability to prevent infant mortality, which is covered in MDG Goal # 4.    

“We are having 20 000 still-births in South Africa every year. The number of neo-nates - the new-borns - who die before their first year has reached 22 000. The number who die before they reach five years has reached 75 000 and 43% of these deaths, the contributing factor, is HIV and AIDS, and we believe we should not only try to decrease the issue of mother-to-child transmission, but we should try to eradicate it altogether. This should be achievable in the next five years”, said Health Minister, Dr Aaron Motsoaledi.

In April, South Africa introduced new and better guidelines for the prevention of mother-to-child HIV transmission and the treatment of people co-infected with HIV and TB. More people are now accessing preventative and life-prolonging medicines. But more still needs to be done to reach those left out of the system.

Executive Director of the Global Fund to fight AIDS, TB and Malaria, Professor Michel Kazatchkine, urged South Africa to step up its efforts. Kazatchkine urged South Africa to remember the pleas made by the late child activist Nkosi Johnson and Constitutional Court Judge, Edwin Cameron as well as former president, Nelson Mandela, at the 13th International AIDS Conference in Durban in 2000, when they asked for a better response to HIV and AIDS, which is covered in MDG # 6. 

“I remember Nkosi Johnson who spoke in the stadium at the opening ceremony and gave a face and a voice to children living with HIV. I remember Judge Edwin Cameron who urged us to, quote: ‘Make the future different’. And, of course, I remember vividly President Mandela who spoke passionately about the fact that something needs to be done, quote: ‘As a matter of greatest urgency’, said Kazatchkine.

“So, ten years later, let us not forget these words. Let us not forget that only half of the patients in urgent need have access to life-saving treatment; that access to prevention measures remains too limited; and that human rights abuses against people living with HIV and most at risk groups of the population continue. Let us, therefore, also resolve to follow through on what Nkosi Johnson, Edwin Cameron and Nelson Mandela asked us to do”, he urged.      

Together with AIDS, combating malaria forms the basis of the United Nations’ Millennium Development Goal # 6. In its response to Malaria, South Africa has partnered with eight countries in the southern African region to form E8 or Elimination 8. The eight countries have vowed that, at least, by 2020 they should have eliminated malaria from the SADC community. The road still to be traveled to achieving these goals is not too long. One of the key determinants for success is finance. There is concern that African governments will not attain these objectives as the global community is shrinking their aid to poor countries. Poor countries themselves are spending too little on their health programmes.

Millennium Development Goals: Fight against AIDS Hit by $10bn Shortfall. 19/9/10

Success in halting infection in sub-Saharan Africa could falter as international aid starts to shrink, warns UNAids chief

The Observer

A decade-long effort to reverse the spread of HIV/Aids in sub-Saharan Africa – which has seen new infections drop by a dramatic 25% in some of the worst-hit areas – is under threat because of a massive shortfall of funds.

The fight against HIV has been one of the success stories of the eight Millennium Development Goals, which aim, with MDG 6, to halt and reverse the spread of the disease by 2015. New infections have fallen by more than 25% in 22 countries in sub-Saharan Africa. This is the region hardest hit by HIV, accounting for 67% of all people living with the virus worldwide, 71% of Aids-related deaths and 91% of all new infections among children.

"The world has made a giant leap towards reaching MDG 6. It is within our grasp," Michel Sidibé, the head of UN HIV/Aids agency UNAids, said last week. However, he warned that European countries were giving $623m less this year to HIV/Aids programmes around the world, and there is a shortfall of $10bn in the funds needed to achieve universal access to HIV treatment, including prevention programmes, setting up healthcare systems and caring for HIV orphans.

"I am scared," he told Reuters AlertNet. "For the first time, we are seeing a decline in financial commitment from donor nations."

African countries with the biggest epidemics, such as Nigeria, South Africa, Zambia and Zimbabwe, have seen some of the biggest falls in the infection rate, thanks to better use of prevention methods and greater access to life-preserving drugs, according to a UNAids report charting the progress of the globally agreed MDG.

"For the first time change is happening at the heart of the epidemic," Sidibé said. However, he added that the $10bn shortfall in the funding for HIV/Aids in 2009 could put further progress at risk. UNAids said an estimated $25.9bn was needed for the global response, of which only $15.9bn is currently available.

The success seen so far in sub-Saharan Africa is extraordinary given the deep pessimism that existed a decade ago over the hold of the disease there. The figures reflect the striking impact of a large, effective and well-funded prevention programme matched with better treatment for those with the disease.

Success in Africa, however, is in danger of being overshadowed by the spread of infection in eastern Europe and central Asia, both of which have rapidly expanding HIV epidemics – the disease is spreading in those regions at a rate of 500 new infections a day.

UNAids said access to treatment for HIV has increased 12-fold in six years, and 5.2 million people now get the drugs they need. But another 10 million who need the drugs do not get them.

"To sustain the gains we are making, further investments in research and development are needed – not only for a small wealthy minority, but also focused to meet the needs of the majority," Sidibé said.

UNAids recommends governments allocate between 0.5% and 3% of their revenue to combating HIV and Aids, depending on the prevalence of disease in their country.

Replenish or MDGs perish. 22/9/10

World leaders have two weeks left to find the $20billion the Global Fund needs to set the world on track to meet the Health MDGs

Maternal health and child mortality Millennium Development Goals in many countries can only be met if AIDS, TB and malaria are addressed and the Global Fund replenished with $20 billion over the next two weeks, say activists.

Activists to call a Day of Action on Tuesday September 28 in at least 20 African cities, and supported by groups around the world, to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria

Wednesday September 22 (Nairobi, Washington)--World leaders have two weeks left to find the $20billion the Global Fund needs to set the world on track to meet the Health Millennium Development Goals (MDGs), activists said today at the start of a week of activism which culminates in a Global Day of Action next Tuesday September 28 to advocate for the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

At the recently concluded MDG Summit in New York UN Secretary-General Ban Ki-Moon declared that the MDGs are achievable, and called on donors to open their pockets at the Global Fund Replenishment meeting he is chairing 4-5 October.

“We are delighted that the world has woken up to the fact that efforts to tackle child mortality and maternal health (MDGs 4 and 5) are off-track – but politicians are making a grave and foolish error if they think they can deal with this at the expense of the fight against HIV/AIDS, TB and Malaria (MDG 6),” said Rachel Ong, Chair of the Global Network of People living with HIV/AIDS (GNP+) and one of the initiators of the Global Fund replenishment campaign. “Maternal health and child mortality goals have no place being pitted in competition with action to tackle AIDS, TB and malaria.”

In South Africa AIDS is the main cause of death among women and children, and throughout Africa AIDS, TB and malaria are killing millions of children and women every year.

“The choice is simple: replenish or the MDGs will perish,” said Vuyiseka Dubula, the HIV+ Secretary General of South Africa’s Treatment Action Campaign (TAC), one of the leading forces behind the Global Week of Action. “If leaders have decided that maternal and child mortality are the problem, then they must know that finding $20billion for the Fund is a big part of the solution.”

In less than a decade the Global Fund has saved nearly 6 million lives and the organisation is highly regarded as a responsible steward of donor money, already proving itself capable of handling traditional aid and innovative financing.

“All countries should play their role. Contributions are needed from all governments, including lower-income countries, who have a duty to prioritise health. But the urgent priority right now is to replenish the Global Fund to put the world on track to meet the health MDGs,” said Paula Akugizibwe from the AIDS and Rights Alliance for Southern Africa (ARASA). “The establishment of the Global Fund was an unprecedented show of unified political will to respond to pressing global health crises. If governments turn their backs on their own commitments now after all the progress that has been made, they are sending the clear message that they view health – and hence, basic human development – as optional, depending on the price tag.”

Ong Akugizibwe and Dubula are among a global coalition of activists who have convened a week of activism culminating in a Global Day of Action to demand that the Global Fund gets the funds it needs. The week of action started on Monday 20 September with marches in Paris, France and outside the UN MDG Summit in New York.

It culminates on Tuesday 28 September in dozens of marches, press conferences and other actions organised by community groups across the African region taking place in Kenya, South Africa, Swaziland, Zambia, Lesotho, Malawi, Botswana, Mauritius, Tanzania, Mali, Ethiopia, Cameroon and Nigeria. At the same time a viral video campaign will be launched across 30 Asian countries, and supportive actions will take place in Canada, Italy, Russia and other places.

Tracking Progress on MDG Six. 21/9/10

major gaps remain that could prevent many countries from achieving the 6 MDGs

Nairobi - Significant strides have been made in the global fight against HIV, but major gaps remain that could prevent many countries from achieving UN Millennium Development Goal (MDG) six relating to HIV/AIDS, malaria and other diseases.

IRIN/PlusNews examines global efforts to halt and begin to reverse the spread of HIV/AIDS.

Access to treatment - More than five million people currently have access to life-prolonging antiretroviral drugs, a 12-fold increase over the past six years. However, this still represents just one third of people who need HIV treatment.

In 2008, 38 percent of the 730,000 children estimated to need antiretrovirals (ARVs) in low- and middle-income countries had access to them.

UNAIDS is calling for the implementation of a new treatment approach called "Treatment 2.0", to drastically scale up testing and treatment; it estimates that successful implementation of "Treatment 2.0" could avert 10 million deaths by 2025, and reduce new infections by a third.

New infections - Twenty-two of the worst affected countries in sub-Saharan Africa have reduced HIV incidence by more than 25 percent in the last eight years, according to UNAIDS. Some of the best performers in reducing new infections are Ethiopia, Nigeria, Zambia and Zimbabwe; HIV incidence is on the rise in Uganda, once a leader in the fight against HIV.

Eastern Europe and Central Asia remain the only regions where incidence is increasing.

Globally, there are still five new infections for every two people put on ARVs.

Prevention of mother-to-child transmission - According to the UN World Health Organization's (WHO) 2009 report, Towards Universal Access, the 20 countries with the highest burden of HIV among pregnant women have scaled up HIV counselling and testing to at least 75 percent of their antenatal care facilities.

Kenya, Malawi, Mozambique, South Africa, Tanzania and Zambia are among the countries that provided HIV testing to 60-80 percent of pregnant women, while Botswana, Namibia and São Tomé and Principe exceeded the 80 percent mark.

In 2008, 45 percent of pregnant women living with HIV in low- and middle-income countries received ARVs to prevent HIV transmission to their infants - up from just 10 percent in 2004.

HIV-related maternal and child mortality - In 2008, 9 percent of all maternal deaths in sub-Saharan Africa were HIV related, according to a new report, Trends in Maternal Mortality: 1990-2008 by WHO and the UN Children's Fund, UNICEF. In Latin America and the Caribbean, HIV/AIDS was responsible for 5.2 percent of maternal deaths.

The report notes that there is evidence that women with HIV infection have a higher risk of maternal death.

Access to prevention of mother-to-child-transmission (PMTCT) improves outcomes for children as well, with studies showing that in KwaZulu Natal, South Africa, child mortality declined by 34 percent following improvement in PMTCT. According to UNICEF, HIV is one of four diseases that accounted for 43 percent of all deaths in children under five worldwide in 2008.

Condom availability and use - Globally, condom use has doubled over the past five years, according to UNAIDS. An estimated 13 billion condoms per year will be needed by 2015 to help halt the spread of HIV, but only four condoms were available for every adult male of reproductive age in sub-Saharan Africa.

Female condoms are even less accessible. According to the UN Population Fund, UNFPA, in 2009, one female condom was distributed for every 36 women worldwide.

Condom use remains low in many high prevalence countries. According to UNAIDS, in South Africa, the proportion of adults reporting condom use during last sex rose from 31 percent in 2002 to 65 percent in 2008, but in Burundi, only about one in five people reported using a condom during commercial sex episodes.

New prevention technologies - The first positive results from a microbicide trial have injected fresh hope into efforts to halt the spread of the virus; the gel, containing the ARV Tenofovir, was found to be 39 percent effective in reducing a woman's risk of becoming infected with HIV.

"Treatment 2.0" also promises benefits for prevention, with evidence showing that people on ARV treatment are much less likely to transmit the virus.

A Thai vaccine trial completed in 2009 also provided the first evidence that a vaccine can provide some protection against HIV.

Several trials are under way to test the efficacy of pre-exposure prophylaxis (PrEP) whereby HIV-negative people take a single ARV drug or a combination of drugs with the hope that it will lower their risk of infection if exposed to HIV.

Male circumcision, proven to reduce men's risk of infection through sexual intercourse by up to 60 percent, is being rolled out in several African countries

Tuberculosis - TB remains a major cause of death for people living with HIV. WHO estimates that in 2008, there were 1.4 million TB cases among people living with HIV and over 500,000 deaths. Drug-resistant TB is on the rise in several countries, but diagnosis remains very low.

TB research remains under-funded and the most widely used TB diagnostics are over 100 years old. For many co-infected patients in the developing world, late diagnosis leads to death.

The authors of a recent article published in medical journal The Lancet argue that TB control is crucial to achieving the MDGs, given its link to HIV mortality as well as maternal and child mortality.

Recent developments such as a new drug to treat TB and rapid, more accurate TB tests could lead to improvements in the diagnosis and management of the highly infectious disease.

New research showing that starting TB patients on ARVs earlier leads to better outcomes could also reduce mortality in co-infected patients.

UN Chief Urges World Leaders to Meet Millennium Goals. 20/9/10

U.N. Secretary-General Ban Ki-moon has called on world leaders to reaffirm their commitments to drastically reducing global poverty, hunger and disease within the next five years

Voice of America News

World leaders have gathered in New York for a three-day summit on ending global poverty, hunger and disease within the next five years. The secretary-general called on the international community to keep its promise to help the world's most vulnerable people.

U.N. Secretary-General Ban Ki-moon said when leaders agreed on the eight Millennium Development Goals during a summit in 2000, it was a great breakthrough.

"Together we created a blueprint for ending extreme poverty. We defined achievable targets and timetables," he said. "We established a framework that all partners, even those with different views have been able to embrace."

This week's summit is intended to review progress, identify gaps and commit to concrete steps to reach the Millennium Development Goals on schedule. A document setting out specific actions on how to do that for each of the eight goals has already been agreed on and is expected to be adopted at the end of the summit.

The goals include eradicating extreme hunger and poverty, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality, improving maternal health and combating HIV/AIDS, malaria and other diseases.

Mr. Ban outlined some of the successes during the past 10 years in implementing the goals:

"New thinking and path-breaking public-private partnerships," he said. "Dramatic increases in school enrollment. Expanded access to clean water. Better control of disease. The spread of technology - from mobile to green."

But progress has been uneven, and the summit aims to give a boost to the goals that are lagging, such as improving maternal health and reducing child mortality. On Wednesday, the Secretary-General will launch a Global Strategy for Women's and Children's Health as part of that effort.

The latest MDG progress report warns that several of the goals are likely to be missed in many countries. The challenges are greatest in the least-developed countries, land-locked developing countries and small island developing states, as well as countries either in or emerging from conflict and those most affected by climate change.

The report also found the global economic and financial crisis has impacted jobs and incomes worldwide, severely hurting the ability of the poor to feed their families. There is also concern that donor countries affected by the financial crisis are taking austerity measures that could erode their contributions to development assistance.

The secretary-general has warned that falling short of the Millennium Development Goals could lead to an increase in global dangers from political instability to disease to harming the environment.

About 140 world leaders, including President Barack Obama will address the summit before it concludes Wednesday.

UNAIDS Board Adopts New Strategy to Help Achieve 2015 HIV Goals. 8/12/10

The Board also approved measures for greater internal efficiency and effectiveness and examined issues such as gender-sensitivity of AIDS responses, ‘AIDS, security and humanitarian responses’ and ‘food and nutrition security and HIV’

GENEVA, 8 December 2010—The governing body of the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Programme Coordinating Board (PCB), has adopted a new UNAIDS strategy to advance global progress in achieving universal access to HIV prevention, treatment, care and support services and to halt and reverse the spread of HIV. 

The strategy, for the period 2011-2015, was endorsed during the 27th Board meeting, which took place in Geneva from 6-8 December. The AIDS response is a long term investment and the strategy aims to revolutionize HIV prevention, catalyse the next phase of treatment, care and support, and advance human rights and gender equality.

Priority areas highlighted in the strategy include: stopping new HIV infections; integrating the AIDS response into other health and development efforts; setting goals to end stigma and discrimination; promoting new and innovative partnerships; and focusing on accountability and country ownership of national responses.

In his report to the Board, UNAIDS Executive Director Michel Sidibé said, “Now more than ever, the AIDS response must deliver value for money. This strategy has been designed to produce high-quality, high value results far into the future.”

The UNAIDS strategy is a roadmap for the Joint Programme with concrete goals marking milestones on the path to achieving UNAIDS’ vision of “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.”

The strategy will also be used as a reference in the lead up to the High Level Meeting on HIV in June 2011. United Nations Member States will come together next year to review progress made since the 2001 Declaration of Commitment on HIV/AIDS and commit to actions in taking the response forward.

In putting the strategy into operation, UNAIDS will focus on value for money in the effective and efficient delivery of business practices. It will also ensure that resources are focused for results and guided by the Unified Budget and Accountability Framework.

At the PCB meeting, Board members strongly supported the decision to move to a single administrative system for the UNAIDS Secretariat. It encouraged ongoing efforts to use the most effective administrative policies and to minimize administrative costs by seeking the most cost-effective provision of services.

During the meeting, the Board was presented with a comprehensive report on UNAIDS’ activities in relation to gender and HIV. This included a review of the action framework and implementation of UNAIDS’ operational plan for women and girls. The links between sexual and reproductive health and HIV were also covered.

Dr Françoise Barré-Sinoussi, Co-Chair of the UNAIDS High Level Commission on HIV Prevention and Nobel Prize laureate for Medicine in 2008 for her role in the discovery of HIV, addressed the PCB as its keynote speaker. The Board also held a thematic session, led by UNAIDS Cosponsor the World Food Programme, focused on food and nutrition security and HIV.

More than 300 participants and observers from UN Member States, international organizations, civil society and non-governmental organizations attended the meeting, which was chaired by the Netherlands with El Salvador acting as vice chair and Japan as rapporteur. In 2011, El Salvador will assume the role of chair, and the Board elected Poland as vice chair and Egypt as rapporteur.

The UNAIDS Executive Director’s report to the Board, the decisions, recommendations and conclusions, and an overview of all documents presented at the meeting can be found on the 27th PCB web page.

World Failing to Meet 2010 HIV/AIDS Care Target: UN. 29/9/10

Fail to meet an end-2010 deadline for "universal" access to HIV/AIDS care and treatment

Asia One Health

Geneva (AFP) - UN agencies warned on Friday that the world will fail to meet an end-2010 deadline for "universal" access to HIV/AIDS care and treatment, while new crisis-driven funding cuts could unravel any gains.

The World Health Organisation, UNAIDS, and the UN Children's Fund UNICEF said in a joint report that the target of universal access - defined as access for 80 percent of the HIV positive population - to prevention, treatment and care was within "clear reach" for "a good number of countries."

"Nevertheless, this report also demonstrates that, on a global scale, targets for universal access to HIV prevention, treatment and care will not be met by 2010," the report said.

Despite accelerating progress, the report covering 183 nations underlined that only one-third of those in need worldwide have access to life-saving anti-retroviral drugs to counter the human immunodeficiency virus (HIV) that causes AIDS.

Some 5.2 million people received such treatment last year in low to middle income countries, the key battleground for the fight against the near three decades old pandemic with the highest burden of the disease.

That marked a 30 percent increase over a year earlier and a 13-fold increase in six years, but another 10 million people approximately did not have such treatment in those countries.

Only eight middle to low income nations - including Cambodia, Cuba and Rwanda - had achieved the treatment target by the end of 2009, it found.

The agencies spearheading the fight against HIV/AIDS underlined that the scale of prevention measures was still insufficient, four years after the UN's member states set the broad 2010 access target.

"It's unacceptable that 7,000 people a day are dying of a chronic, treatable illness," added Kevin Moody of the Global Network of People Living with AIDS.

The report also estimated that most people with HIV were still unaware that they were infected - about 60 percent of people in low and middle income countries, WHO HIV/AIDS coordinator Yves Souteyrand told journalists.

The most vulnerable, including those with HIV, sex workers, drug users, men with a homosexual experience and migrants were still victims of stigma and discrimination, adding to their marginalisation from treatment and care, the report argued.

"At the same time, the financial crisis and resulting economic recession have prompted some countries to reassess their commitments to HIV programmes," it added.

Reduced funding "risks undoing the gains of the past years," said the heads of the agencies, including WHO Director General Margaret Chan, amid warnings that the effort was 10 billion dollars short last year.

More than 33 million people around the world have HIV, according to most recent UN estimates for 2008.

The report nonetheless highlighted patchy progress in 144 low and middle income countries, with "significant" inroads in several impoverished and hardest hit sub-Saharan African countries.

More than 80 percent of HIV positive pregnant women received services and medicines to prevent mother-to-child transmission in 15 such nations, including Botswana and South Africa.

Fourteen countries, including Brazil, Namibia and Ukraine, provided HIV treatment for children in need.

"We are on the right track, we've shown what works and now we need to do more of it," said Paul De Lay, deputy executive director of UNAIDS.

In 2003, the WHO and UNAIDS set a similar target with the "Three by Five" initiative, which aimed to give three million infected people in poor countries access to anti-HIV drugs by the end of 2005.

It also missed, some 1.7 million short, although the WHO said the goal was fulfilled by 2007 after initially helping to triple the number of people on antiretrovirals.

Wednesday's report urged more political pledges and funding, as agency officials set their sights on universal access in 2015.