In recent years, the AIDS response in China has seen increasing civil society involvement in focused, community-based HIV prevention and treatment programming, which has contributed to maintaining low levels of HIV prevalence in the country and ensuring an increasingly evidence-informed, tailored response.

The strategies, progress and achievements of Chinese civil society organizations were the focus of a session at the 21st International AIDS Conference, taking place in Durban, South Africa, which brought together representatives of the Government of China, Chinese civil society, the World Health Organization and UNAIDS.

The session, held on July 20, showcased the China State Council approved Fund for Participation of Civil Society Organizations in AIDS Prevention and Care, which has invested 50 million renminbi (nearly US$ 7.5 million) to support the work of nongovernmental organizations in education, communication, testing, counselling, care and support, including with key populations.

Although overall HIV prevalence continues to be low, the absolute number of people living with HIV and the annual number of new HIV infections remain significant, particularly among key populations. Recognizing that social and community organizations that have the trust of key populations are best able to reach at-risk communities, the fund—which has been designed, established and implemented in partnership with UNAIDS—is playing an important role in increasing prevention and treatment programmes for key populations in China.

Opening the session in Durban, UNAIDS Executive Director Jan Beagle underlined how China has undertaken impressive efforts to analyse its epidemic and tailor its response. Recalling the visit of a delegation from the UNAIDS Programme Coordinating Board (PCB) to China in May 2016 to explore the national response and the role of communities, Ms Beagle noted how the PCB delegation had seen first-hand that cost-effective and rights-based approaches that focus on populations and locations were proving to have impact.

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UNAIDS Executive Director Michel Sidibé has presented the President of Xinhua News Agency, Cai Mingzhao with the UNAIDS Leaders and Innovators Award in recognition of his leadership as a media partner and his contribution to the AIDS response

BEIJING, 28 July 2016—In recognition of the key role that media plays in the Fast-Track response to ending the AIDS epidemic, Cai Mingzhao, the President of Xinhua News Agency, has been presented with the UNAIDS Leaders and Innovators Award at an event held during a joint cooperation visit to Xinhua headquarters in Beijing, China.

The award recognizes Mr Cai’s efforts towards reaching the globally shared vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths. 

“Mr Cai is a leader with vision. He understands that the three zeros are not just about the numbers but about social justice and inclusion," said the Executive Director of UNAIDS, Michel Sidibé. “AIDS is not over in any part of the world and Mr Cai’s leadership is helping to ensure that HIV remains at the forefront of public awareness so that no one is left behind.”

With Mr Cai at the helm of Xinhua, the media news group has promoted public awareness of HIV in China and abroad. During the United Nations General Assembly High-Level Meeting on Ending AIDS in June 2016, Xinhua showcased UNAIDS “Fast-Track to an AIDS-Free Generation” message on a giant electronic screen in Times Square, New York. In addition, the group is working with UNAIDS to promote zero discrimination messages through social media and other platforms. 

“We understand that the fight against AIDS requires concerted efforts from the whole of society — especially the media.” said Mr Cai. “We have a key role to play to ending AIDS." 

UNAIDS recognizes the unique role of the media in the global effort to end the AIDS epidemic. Media is able to reach billions of people with important life-saving messages and to encourage engagement and action. With more than 30 domestic branches and nearly 170 offices overseas, Xinhua is one of the largest news agencies in the world.

The Vice-Minister of Information at the Office of the State Council, Guo Weimin, underlined the importance of Xinhua’s contribution. "Xinhua News Agency is an active supporter of the United Nations Sustainable Development Goals and promotes efforts to involve more people in achieving these aims."

The Vice-Minister of the National Health and Family Planning Committee, Cui Li said, "The cooperation between Xinhua News and UNAIDS is a good example of multi-sector participation and cooperation in advancing the AIDS response."  

In March 2016, UNAIDS and Xinhua signed a two-year Memorandum of Understanding of Strategic Cooperation to find innovative solutions to end the AIDS epidemic as a public health threat by 2030 within the framework of the Sustainable Development Goals. 

UNAIDS

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

UNAIDS has appointed the singer and television personality Chalatit Tantiwut as a UNAIDS National Goodwill Ambassador for Thailand.

The announcement was made on 1 July during a special National HIV Testing Day event hosted by the Bangkok Metropolitan Administration (BMA). The Deputy Governor of Bangkok, Pusadee Tamthai, was among the first to congratulate him. 

Mr Chalatit will help raise awareness and promote greater use of HIV prevention, treatment, care and support services, particularly among gay men and other men who have sex with men.

Thailand has made immense progress in its AIDS response, with new HIV infections dropping by 56% since 2005. At the same time, there is a continuing epidemic among gay men and other men who have sex with men, especially in large urban areas. BMA’s Department of Health reports that in 2014 HIV prevalence among gay men and other men who have sex with men was 28.6% in Bangkok, which was much higher than among the general population.

Mr Chalatit’s powerful voice has entranced Thailand’s music scene for more than a decade. He has recorded numerous hits and has also acted in movies and television series.

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The Tangerine Community Health Centre is Asia’s first clinic to provide a full range of health-care and counselling services specifically for transgender people. Transgender people need access to a range of health, social protection and other support services that are tailored to them.

“At the Thai Red Cross Tangerine Community Health Centre we are committed to providing the highest attainable standard of health in an affordable and accessible manner for all transgender people,” said Praphan Phanuphak, Director of the Thai Red Cross AIDS Research Centre, in which the clinic is located.

UNAIDS Deputy Executive Director Luiz Loures visited the clinic with Mr Praphan, its founder, on 21 June. The clinic provides hormone counselling and therapy, sexual and reproductive health services, psychosocial counselling and HIV testing. Trained transgender personnel and gender-sensitive medical professionals manage and provide the services. While the clinic offers a full range of services, it encourages all clients to have an HIV test.

“We like to encourage everyone to have an HIV test and learn more about HIV prevention and treatment as part of a holistic approach to health care for transgender people,” said Krittima Samitpol, Supervisor of the Tangerine Community Health Centre.  

According to Thailand’s Bureau of Epidemiology, epidemiological surveys of transgender women at five sites report high HIV prevalence, ranging from around 9% to 17% in 2014. Despite the risk of HIV infection, many transgender people do not get tested for the virus and studies find only about a third know their HIV status.

Most transgender people in Thailand self-administer hormones they commonly purchase on the Internet or in local pharmacies. Without professional medical care, incorrect use of hormones can lead to liver, kidney and cardiovascular problems. At the Tangerine Community Health Centre, medical professionals oversee testosterone injections for transgender men and transdermal hormone creams and oral hormone therapy for transgender women.

The Political Declaration on Ending AIDS adopted in early June by United Nations Member States noted with alarm the slow progress made in reducing new HIV infections among specific populations.

“To end AIDS, the health and rights of key populations need to be at the centre,” said Mr Loures. “The Tangerine Community Health Centre is transforming the health choices for transgender people.”

The clinic opened in November 2015 and in its first five months received visits from nearly 250 transgender people. Around 80% of the visitors were tested for HIV and the 10% who tested positive were linked to treatment at either the Thai Red Cross AIDS Research Centre or public hospitals.

During his visit to the clinic, Mr Loures spoke with representatives of three community groups: the Thai Transgender Alliance, Service Workers In Group and Rainbow Sky.

The Prime Minister of Thailand, Prayut Chan-o-cha, received a certificate from the World Health Organization (WHO) on 20 June confirming the elimination of mother-to-child transmission of HIV and syphilis in the country. Thailand is the first country in Asia to reach the milestone, which was officially announced earlier this month at the United Nations General Assembly High-Level Meeting on Ending AIDS.

UNAIDS Deputy Executive Director Luiz Loures, WHO Regional Director for South-East Asia Poonam Khetrapal Singh, the Minister of Public Health of Thailand, Piyasakol Sakolsatayadorn, and representatives of other organizations and partners participated in the event, which took place in Bangkok, Thailand.

According to Thailand’s Ministry of Public Health, 98% of all pregnant women living with HIV have access to antiretroviral therapy and the rate of mother-to-child transmission of HIV has been reduced to 1.91%. WHO’s global guidelines consider mother-to-child transmission of HIV to be effectively eliminated when the rate of transmission falls below 2%.

In 2000, an estimated 1000 children became infected with HIV through mother-to-child transmission. By 2015, that number had dropped to 85. This is a significant achievement in a country where an estimated 440 000 people were living with HIV in 2015.

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NEW DELHI/BANGKOK, 7 June 2016— Thailand today received validation from WHO for having eliminated mother-to-child transmission of HIV and syphilis, becoming the first country in Asia and the Pacific region and also the first with a large HIV epidemic to ensure an AIDS-free generation.  The Minister of Health of Thailand was presented with the certificate of validation during a ceremony which took place in New York on the eve of the United Nations General-Assembly High-Level Meeting on Ending AIDS.

 “This is a remarkable achievement for a country where thousands of people live with HIV. Thailand’s unwavering commitment to core public health principles has made elimination of mother-to-child transmission of HIV and syphilis a reality, a critical step for rolling back the HIV epidemic. Thailand has demonstrated to the world that HIV can be defeated,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region, said presenting the certificate of validation to Thailand in New York.

"Thailand has turned around its epidemic and transformed the lives of thousands of women and children affected by HIV," said UNAIDS Executive Director, Michel Sidibé. "Thailand's progress shows how much can be achieved when science and medicine are underpinned by sustained political commitment."

"By investing in strong maternal and child health care and national AIDS prevention measures, Thailand has demonstrated there are ways to protect children from the global AIDS pandemic response,” said Karin Hulshof, Regional Director, UNICEF East Asia-Pacific Region. “Thailand’s achievement inspires its neighbours to greater action. There are still 21,000 infants who are born with HIV each year in the Asia-Pacific region, and more than 200,000 children who are growing up with HIV.”

Untreated, women living with HIV have a 15-45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, that risk drops to just over 1% if antiretroviral medicines are given to both mothers and children throughout the stages when infection can occur.

According to Thailand’s Ministry of Public Health 98% of all pregnant women living with HIV have access to antiretroviral therapy and the rate of mother-to-child transmission of HIV has been reduced to less than 2%. In 2000, an estimated 1000 children became infected with HIV. In 2015, the number of children who became infected with HIV through mother to child transmission was reduced to 85, a decline of more than 90%, a significant achievement in a country where an estimated 450 000 people were living with HIV in 2014.

At the same time, sustained efforts and success in preventing new HIV infections have helped reduce HIV among women of childbearing age. According to Thailand’s health authorities, between 2000 and 2014, the annual number of women newly infected with HIV fell from 15 000 to 1 900 – a 87% reduction. Thailand’s Universal Health Coverage framework ensured essential health services were available to both rich and poor. The country’s commitment to equitable access has ensured that both Thai citizens and migrants are covered for HIV treatment.

Thailand’s commitment to the UNAIDS-led ‘Global Plan towards the elimination of new HIV Infections among children by 2015 and keeping their mothers alive’, combined with the Government’s decision to provide all pregnant women – including documented and undocumented migrant workers – free antenatal care, delivery and services for HIV and syphilis pushed treatment coverage rates up, culminating in validation of elimination of mother-to-child transmission.

Thailand’s pioneering success and leadership demonstrates how countries can make real change when good policy is followed up with high-level commitment. WHO, UNAIDS and UNICEF will continue to work with other countries in the region, along with partners to replicate Thailand’s success.

WHO validation process

In 2014, WHO and key partners published the guidance on global processes and criteria for the validation of the elimination of mother-to-child transmission of HIV and syphilis, which outlines the validation process and the different indicators countries need to meet.

As treatment for prevention of mother-to-child-transmission is not 100% effective, elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.

An international expert mission convened by WHO visited Thailand in April 2016 to validate the progress toward the elimination of mother-to-child transmission of HIV and syphilis. The members visited health centres, laboratories, and government offices, and interviewed health officials and other key actors. The mission included experts from Australia, Cambodia, China, Philippines, India, Indonesia, Nepal, Thailand, United States and representatives from WHO, UNICEF and UNAIDS.

Video on Thailand's success:  https://www.youtube.com/watch?v=eVIh3pnnOh4&feature=youtu.be

UNAIDS

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

A delegation of the UNAIDS Programme Coordinating Board (PCB) visited China from 9 to 12 May to get insight into how the country’s national AIDS response is on the Fast-Track to end the epidemic as a public health threat by 2030.

The PCB delegation met representatives of the government, civil society and the private sector. Innovative and focused strategies, the engagement of non-traditional stakeholders, accelerated efforts and the importance of political leadership and advocacy on AIDS were identified as critical to Fast-Track the national AIDS response in China.

Confirming China’s commitment to the Sustainable Development Goal target of ending AIDS by 2030, the Vice-Minister of Health, Wang Guoqiang, emphasized China’s support for a strong Political Declaration on Ending AIDS at the United Nations General Assembly High-Level Meeting on Ending AIDS to be held in June. This would be an important driver for further acceleration of the AIDS response globally and in China.

China’s epidemic is concentrated among key populations at higher risk of HIV. Men who have sex with men, especially in major cities, are particularly vulnerable to HIV infection. HIV is prioritized at the highest levels of government and is addressed across sectors. The response is funded almost entirely from domestic resources.

“China’s leadership on HIV is an example of shared responsibility in action, with multisectoral approaches engaging the government, civil society and the private sector drawing on comprehensive national data,” said UNAIDS Deputy Executive Director Jan Beagle, who led the visit. “This can provide important lessons learned across continents, for South–South collaboration and particularly on sustainability,” she added.

Combining science, technology and community action for results

A variety of innovative approaches were showcased during the visit, including Beijing’s response to HIV. The city engages community-based organizations for enhanced service delivery. In addition, it has adopted a one-stop-shop model for HIV testing, has accelerated the test and treat strategy among men who have sex with men, has piloted HIV self-testing programmes and uses new technologies to support HIV prevention and treatment initiatives.

The PCB delegation made a site visit to Danlan, a nongovernmental organization advocating for lesbian, gay, bisexual and transgender rights. Danlan has combined a community-driven HIV prevention programme with a social enterprise scheme through social media—its dating application Blued, which has some 15 million users, includes links to HIV prevention and treatment services. The founder of Danlan, Geng Le, underlined how Blued provides an example of how combining science and technology can integrate the HIV response into the lives of people away from clinics and hospitals.

In discussions with the PCB delegation, members of Beijing’s Health and Family Planning Committee emphasized that their data are showing that community-based organizations, such as Danlan, have been particularly effective in carrying out rapid testing campaigns that reach communities at higher risk of infection. Although small in size, such campaigns have identified some 30% of all new HIV cases in the city.

The private sector’s role

The visit also focused on private sector engagement and action on AIDS within the Chinese national response.

The delegation met with the Red Ribbon Foundation, a national philanthropic fund comprising some 50 companies that are raising funds, providing materials and cooperating with the government on accelerating AIDS efforts.

Discussions with the China Chamber of Commerce for Import and Export of Medicines and Health Products (CCCMHPIE) focused on China’s support for the local production of medicines and health commodities in Africa. With the active engagement of UNAIDS, CCCMHPIE is engaging in technology transfer between Africa and China.

The PCB delegation included representatives of Burundi, Ecuador, El Salvador, Ghana, Norway and Switzerland, as well as the PCB nongovernmental organization delegation and UNAIDS Cosponsors. During the visit, the delegation met with a range of national partners, including representatives of the government at the national and city levels, the National AIDS Committee, civil society and community organizations, business leaders, health-care workers, development partners, media representatives and the United Nations Country Team. The delegation visited several sites in Beijing, where the team saw how the city has scaled up access to HIV prevention, testing and treatment services, including prevention of mother-to-child transmission of HIV and community-based responses.

HIV activists in Sri Lanka are celebrating a landmark decision by the country’s Supreme Court that which prohibits HIV discrimination in education settings. 

Princey Mangalika, Executive Director of the Positive Women’s Network in Sri Lanka, said, “I would like to express my appreciation to the Supreme Court. This marks a momentously progressive step forward for the people living with HIV community in Sri Lanka.”

The Supreme Court issued the directive in response to a fundamental rights violation petition filed by Chandani De Soysa in February 2016. Ms De Soysa is from the rural community of Illukhena, Kuliyapitiya, in western Sri Lanka. She was left in difficult circumstances when she lost her husband last September. Ms De Soysa believed strongly that her five-year-old son was entitled to an education and tried to enrol him in the local school. However, the school system denied the boy entry because a rumour was circulating that his father had died of AIDS-related causes and that the boy was HIV-positive.

“I felt dead inside, when my child was not accepted into school, when my own neighbours discriminated against me without any human consideration, I felt lost,” said Ms De Soysa.

Even though it was a violation of her son’s human rights, Ms De Soysa agreed to him taking an HIV test. Although his status was confirmed as negative, the boy was still denied enrolment. Ms De Soysa visited a number of other schools in the area, but they all refused admission.

“It was not an easy decision to make, but I decided that for my child I would fight. I did not want any other parent or child to face such an unbearable situation,” said Ms De Soysa. With support from UNAIDS and the Positive Women’s Network, she filed her petition with the Supreme Court.

The court’s directive, which was released on 28 April, stated that the right to an education of children living with or affected by HIV must be upheld, based on the country’s constitutional directive of universal access to education for children between the ages of 5 and 14 years old.

The Supreme Court also went a step further, reminding the state of its obligation to take necessary measures to protect, promote and respect the human rights of people living with HIV. This is the first court decision in South Asia to make a general pronouncement recognizing the human rights of all people living with HIV and sets a precedent for future cases in Sri Lanka challenging HIV discrimination experienced in settings other than education.

“I would like to give a special note of thanks to all the people out there who offered their support in various forms, from money, food, scholarships, to a simple word of encouragement. I cannot express in words my gratitude for this kindness,” said Ms De Soysa. “My son has a dream to be a doctor one day and I hope he will be an HIV specialist.”

While Ms De Soysa has won the right for her son to attend his local school, she has decided to send her son to a private school, Trinity College in Kandy, which prior to the court’s decision had offered a full scholarship. The school is the alma mater of cricket champion Kumar Sangakkara, who has championed people living with HIV and visited the school to raise awareness of HIV as part of the Think Wise campaign, a joint initiative by UNAIDS, the United Nations Children’s Fund and the International Cricket Council.

“This is a great day for social justice,” said Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. “Sri Lanka’s highest court has stood up in support of people who are being left behind. From now on, no child can be denied access to education based on HIV.”

There have been other cases of children being denied school admission because of their association with HIV, which have been settled through mediation.

HIV-related stigma and discrimination continues to prevent people from accessing key education and health services and reduces employment opportunities. Research conducted by people living with HIV in 13 countries in Asia between 2009 and 2014 found that an average of 12% of HIV-positive people surveyed reported exclusion from social gatherings and activities and 23% said they had been verbally insulted, harassed or threatened.

Sri Lanka’s legal milestone is a big step forward for the rights of people affected by HIV in South Asia. Sindh Province in Pakistan has a comprehensive HIV law, but there is no such protection across the country. India’s courts have ruled to recognize the right to non-discrimination in several specific contexts, including schools; however, a national HIV law has yet to be passed by the parliament. 

The Chinese news agency Xinhua and UNAIDS have renewed their partnership for the AIDS response through a two-year extension of their memorandum of understanding. The agreement was signed during a meeting between UNAIDS Executive Director Michel Sidibé and Xinhua’s President Cai Mingzhao at UNAIDS headquarters in Geneva, Switzerland, on 18 March.

Mr Sidibé thanked Xinhua for its support of UNAIDS and highlighted the importance of strong public-private partnerships to reach millions of people with life-saving information.

Working together is key, said Mr Cai, who reiterated Xinhua’s commitment to raising awareness and advocating around key issues related to ending the AIDS epidemic in China and globally. 

The UNAIDS–Xinhua memorandum of understanding was first signed in September 2011. Efforts carried out during the past years include global media campaigns to promote public awareness of HIV and support for World AIDS Day activities. The current agreement includes showcasing UNAIDS during the United Nations General Assembly High-Level Meeting on Ending AIDS in June on a giant electronic screen in Times Square, New York, United States of America. In addition, Xinhua will work with UNAIDS to publish and distribute a children’s book in China.

Xinhua is the world’s largest news agency, with more than 170 offices overseas and 31 domestic bureaus.

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UNAIDS and the Global Health Workforce Alliance are launching an Agenda for Zero Discrimination in Health Care. The agenda supports a vision for a world where everyone, everywhere, enjoys health services without discrimination and where the health workforce is empowered to provide discrimination-free services to all.

Many people around the world face barriers to accessing quality health-care services and realizing the highest attainable standard of health. The multiple reasons for this vary across countries and communities. Even where health-care services are available and of good quality, people often experience or fear stigma and discrimination, which prevent them from accessing the health services they need and are entitled to receive.

A new report by Asia Catalyst produced in collaboration with eight community-based organizations in Cambodia, China, Myanmar and Viet Nam has documented discriminatory practices in health-care settings specifically against people living with HIV. Findings include experiences of involuntary HIV testing, involuntary disclosure of status, segregation, arbitrary additional expenses imposed due to HIV status and medical advice against pregnancy and for sterilization on the sole basis of HIV status.

The agenda offers a space for collaboration between countries, the World Health Organization, UNAIDS, other United Nations and intergovernmental organizations, professional health-care associations, civil society, academics and others to take coordinated action for achieving zero discrimination in health care.

The agenda will prioritize coherent joint actions in three critical areas:

• Political support: by increasing political commitment through mobilization of all key constituencies, to secure prioritization of this agenda at all levels.
• Implementation: by fostering scale-up of implementation of effective actions to achieve discrimination-free health care.
• Accountability: by promoting monitoring and evaluation frameworks and mechanisms to build evidence, monitor progress and ensure accountability.

The action plan outlines seven priorities; these include: building and sharing evidence and best practices; standard-setting; ensuring meaningful engagement of the people most affected by discrimination in the development, implementation and monitoring of policies and programmes; and strengthening the leadership of professional health-care associations.

A virtual community of practice has been created to mobilize more partners around the shared vision and action plan, to join contact ghwa@who.int. 

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