In order to highlight the need for sustainable and affordable access to quality medicines, the Executive Director of UNAIDS, Michel Sidibé, spoke about the necessity of implementing the African Union Pharmaceutical Manufacturing Plan. Speaking at the opening ceremony of Africa Industrialization Week 2018 in Addis Ababa, Ethiopia, he called for close cooperation with regional economic communities in order to build production cooperation hubs and lead pharmaceutical regulatory harmonization in Africa.

Commitments on gender-based violence and the rights of women made at an event held on the margins of the United Nations General Assembly in September entitled Eliminating Sexual and Gender-Based Violence and Protecting the Health and Rights of Women and Children in Humanitarian Settings were discussed during meetings Mr Sidibé held with Smail Chergui, the Africa Union Commissioner for Peace and Security, and the African Union Special Envoy on Women, Peace and Security, Bineta Diop.

During the meetings, discussions were held on how to increase efforts in responding to HIV in conflict and humanitarian settings and the need to increase awareness on HIV testing and on sexual and gender-based violence. Mr Sidibé and Mr Chergui agreed to conduct a high-level joint mission to South Sudan to highlight the needs of people facing a higher risk of HIV in the country owing to gender-based violence and the protracted conflict.

Also during his visit to Ethiopia, which took place from 17 to 20 November, Mr Sidibe’s met with Ethiopia’s Prime Minister, Abiy Ahmed, who said, “I am committed to change the narrative of Africa and Ethiopia through ongoing reforms and agree to strengthen efforts on people-centred health development for Ethiopia.”

“Thank you for agreeing to champion ending AIDS in Ethiopia and across the continent,” said Mr Sidibé.

The President of Ethiopia’s agenda on gender and peace and the rehabilitation of street children was the topic of conversation in a meeting between the President, Sahle-Work Zewde, and Mr Sidibé.

During a discussion Mr Sidibé had with the Minister of Health of Ethiopia, Amir Aman, a collaborative project was developed that will be centred around strengthening resource mobilization, enhancing and sustaining a multisectoral response across all sectors, engaging young people and enhancing HIV programmes following the location–population approach.

On 27 January, the African Commission on Human and Peoples’ Rights (the African Commission) launched a groundbreaking report, HIV, the law and human rights in the African human rights system: key challenges and opportunities for rights-based responses.

The report addresses the key human rights challenges in the response to HIV, including inequality and discrimination towards people living with HIV, access to treatment and restrictive intellectual property regimes, conflict and migration, coercive HIV testing and counselling, restrictions on civil society and the criminalization of people living with HIV and key populations.

While noting the progress made in the response to HIV in Africa, the report expresses concerns about the populations left behind—young women and girls, prisoners, sex workers, men who have sex with men, transgender people and people who use drugs.

As well as the challenges, the report also highlights good practices from across the continent for responding to them, including law and policy reform, progressive court decisions and programmes to advance human rights protection and access to HIV and health services.

The development of the report is the result of three years of work involving inputs from various stakeholders, including people living with and affected by HIV, civil society and members of key populations.

A launch event held during the 30th Ordinary Session of the African Union was attended by the First Lady of Ethiopia in her capacity as Chairperson of the Organisation of African First Ladies against HIV/AIDS and by the Vice-President of Botswana, the Chairperson and Vice-Chairperson of the African Commission and the Executive Director of UNAIDS.

The participants welcomed the comprehensive report on HIV and human rights and its bold recommendations and committed to support the implementation of the report’s recommendations to advance human rights and social justice in the response to HIV in Africa.

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The Italian Government signed on 21 February a financing agreement for €500 000 to support UNAIDS’ efforts to end the AIDS epidemic in Ethiopia. The funds will be invested in a special project to bolster UNAIDS’ work in improving community health education and capacity- and knowledge-building. The project will be implemented across 10 areas of the Southern Nations, Nationalities and Peoples’ Region of the country over a 12-month period.

The Southern Nations, Nationalities and Peoples’ Region, situated in south-west Ethiopia, is the third most populous region in the country, home to some 17.8 million people in 2012, including 80 different ethnic groups distinguished by different languages and cultures. Around 90% of the people in the region live in rural areas, often hard to reach with essential health services. It is estimated that 14% of all new HIV infections in the country are in this region, showing the urgent need to increase HIV prevention and support services.

The joint project will focus on preventing communicable diseases in the region, including HIV, generating demand for and increasing uptake of health services for women and young people and strengthening and building the capacity of support groups for women and young people.

Ethiopia has been particularly affected by the AIDS epidemic. At the peak, in 2005, around 82 000 people died of AIDS-related illnesses. Although much progress has been made in recent years—new HIV infections among children have declined by 87% since 2000 and AIDS-related deaths by 71%—there is still much work to do. The latest estimates show that, in 2014, around 730 000 people were living with HIV in Ethiopia—two thirds of whom were women, and only half had access to treatment. 

The commitment, signed in the Ethiopian capital Addis Ababa, is part of the Italian Ministry of Foreign Affairs and International Cooperation’s efforts to strengthen Italy’s engagement in the response to HIV in Ethiopia and more broadly across the African continent. UNAIDS will be working closely with the Ethiopian and Italian Governments, community partners, civil society and groups of people living with HIV to ensure that Ethiopia is firmly on the Fast-Track to ending its AIDS epidemic by 2030. 

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In 2015 in Africa, 310 000 new HIV infections occurred among adolescent girls and young women between the ages of 15 and 24 years—approximately 6000 new HIV infections per week. In eastern and southern Africa, of the 19 million people living with HIV, women account for more than half (59%), and in western and central Africa 58% of the 6.5 million people living with HIV are women.

These statistics, and an appropriate response to them, were discussed at the Africa Gender Breakfast meeting, held in the run-up to the 28th African Union Heads of State Summit. The meeting was hosted by the Ambassadors to Ethiopia of Australia, Canada and Sweden, as well as the United States of America mission to the African Union, and was attended by the UNAIDS Executive Director, Michel Sidibé, African gender ministers and representatives of civil society and the private sector. The purpose of the meeting was to galvanize the international development community into more urgent action for adolescent girls and young women.

At the meeting, the Australian Minister of International Development and the Pacific, Concetta Fierravanti-Wells, launched a US$ 1 million partnership with the African Union Gender Directorate. Half of these funds will go towards establishing a gender observatory that will produce annual strategic information on the status of women in Africa.

The Canadian Ambassador to Ethiopia, Philip Baker, affirmed that Canada’s international programming will have a renewed focus on gender equality, informed by its recent election onto the Commission on the Status of Women.

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UNAIDS Executive Director Michel Sidibé acknowledged the cooperation between UNAIDS and Italian Development Cooperation in the response to AIDS in Ethiopia during a meeting with the Italian Ambassador, Giuseppe Mistretta, in Addis Ababa, Ethiopia, on 27 January.

Mr Sidibé also expressed his gratitude to the Government of Italy for the recent approval of €500 000 in support of the decentralized HIV response in the Southern Nations, Nationalities and Peoples’ Region (SNNPR) of Ethiopia. The goal of this project is to reduce communicable diseases, including HIV and other sexually transmited infections in SNNPR through programmes focusing on disease prevention, health promotion and strengthening of peer support groups. Special attention will be placed on reaching out to women and young people to ensure their well-being.

UNAIDS and Italian Development Cooperation have been working together to strengthen the engagement of civil society organizations in the AIDS response in the country and to ensure that resources for HIV are used effectively and that accountability mechanisms are in place to ensure results.

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UNAIDS and the One Million Community Health Workers (1mCHW) initiative have announced a major strategic partnership to support the achievement of the 90–90–90 treatment target and to lay the foundation for sustainable health and development.

The new partnership emerged at a high-level meeting of eight African health ministers and other stakeholders in Addis Ababa, Ethiopia, held on 1 February, which focused on the 90–90–90 treatment target and human resources for health. The participants of the meeting called for the world to leverage the aim of achieving the 90–90–90 treatment target to strengthen human resources for health.

In his opening address, Marc Angel, UNAIDS champion for the 90-90-90 treatment target, told participants that increased human resources for health would be essential.     

“Achieving the 90-90-90 target requires health workers, specific expertise and laboratories equipped with the necessary materials,” said Mr Angel.

Jeffrey Sachs, director of the Earth Institute at New York’s Columbia University and founder of the 1mCHW initiative, emphasized his commitment to the 90–90–90 treatment target. As the United Nations Secretary-General’s Special Adviser on the Sustainable Development Goals (SDGs), Mr Sachs pledged to place 90–90–90 at the centre of advocacy for the SDGs.

“The 90–90–90 effort of UNAIDS is historic: a rigorous, scientific and bold approach to end the AIDS epidemic,” Mr Sachs said. “The end of AIDS is within reach, and community health workers will play a pivotal role in empowering communities to end deaths from AIDS and to break the transmission of the virus. The 1 Million Community Health Worker campaign is honoured to join UNAIDS in its path-breaking programme.”

Cosponsored by UNAIDS, the African Union and Ethiopia’s Ministry of Health, the meeting revealed both strong support for the 90–90–90 treatment target and agreement that it offers a unique opportunity to recruit and mobilize hundreds of thousands of community health workers.

“Ethiopia will spare no efforts to reach the 90–90–90 treatment target,” said Kesetebirhan Admasu, Ethiopia’s Minister of Health. “We are determined to relegate AIDS to the books of history.”

To reach the 90–90–90 treatment target, the number of people accessing antiretroviral therapy will need roughly to double over the next five years. While HIV programmes have pioneered innovative strategies to enhance the efficiency of service delivery, it is clear that reaching the target will require expanding the number of health workers available to deliver HIV services.

However, many African countries, as well as countries in other regions, have an acute shortage of health workers. Although Africa accounts for 25% of the global health burden, the region is home to only 3% of all health workers.

To ease health worker shortages, the meeting focused on the importance of training and employing trained, provisioned, supervised and remunerated community health workers to expand access to HIV services. “We must reinforce the interface between communities and the service provider,” said UNAIDS Executive Director Michel Sidibé. “We need to use communities and civil society organizations to reach people who are difficult to reach.”

The 1mCHW campaign unites more than 150 organizations worldwide in a major global effort to recruit and deploy trained, equipped, supervised and remunerated community health workers, with particular attention to especially underserved rural communities.

Countries such as Ethiopia, Ghana and Malawi have already taken major steps to train and deploy community health workers to deliver community-based health services. Ethiopia, for example, has trained tens of thousands of health extension workers, who have substantially increased access to good-quality health services. Creation of the community health worker programme in Ethiopia has been associated with a 19-year increase in life expectancy over two decades. Ghana is in the process of deploying 20 000 community health workers in a national scale-up effort. 

Other countries are moving to emulate these successful national efforts to expand human resources for health. Lesotho, for example, is embarking on a national effort to create a cadre of health extension workers, with mentoring provided by Ethiopia and Malawi.

Much of the discussion during the one-day meeting focused on how the push to achieve the 90–90–90 treatment target can help drive a sustainable expansion of human resources for health. The global effort to achieve the 90–90–90 treatment target will involve the delivery of simplified, decentralized care to millions of healthy people living with HIV. Self-care, including through such innovations as peer-driven adherence clubs and community distribution of antiretroviral therapy, will play a vital role in the delivery of HIV chronic care management.

Community health workers will be essential for providing these simplified, decentralized services. The Fast-Track approach calls for a sharp increase in financing for community service delivery and an increase in the proportion of HIV services that are delivered through community channels from 5% currently to 30%.

The same community-centred models that will be critical for ending the AIDS epidemic as a public health threat also have a potentially key role to play in addressing the other health targets in the SDGs. Community health workers mobilized through the push to achieve the 90–90–90 treatment target can also help in the delivery of other important health services. Similarly, the chronic care models generated by HIV treatment scale-up are applicable to the management of the growing burden of noncommunicable diseases, such as hypertension and diabetes.

Although the road map for action is clear on 90–90–90 and the health workforce, financing remains a potential obstacle, as investments will be needed for training, supervision and compensation for community workers. There was agreement among health ministers and other participants that mobilizing the necessary investments for expanding the health workforce will require both increased domestic outlays and further increases in international assistance. Mr Sachs called for the creation of a fund for strengthening health systems.

“Here in Africa, we must commit our own domestic resources for health,” said Olawale Maiyegun, Director of Social Affairs for the African Union Commission. “We must live up to our commitments in the Abuja Declaration to dedicate at least 15% of our domestic budget to health.”

“Health is not a cost,” Mr Sidibé said. “Health is not expenditure. Health is an investment. If we scale up, we can bring the epidemic to an end. Yet if we don’t come up with the resources we need, AIDS will rebound, and all our investments in the last 30 years will be lost.”

In planning the meeting, the cosponsors worked with the World Health Organization, the African Society for Laboratory Medicine, the International Association of Providers of AIDS Care, the International Federation of Red Cross and Red Crescent Societies, the Office of the United States Global AIDS Coordinator, Columbia University, the Sustainable Development Solutions Network, the One Million Community Health Workers campaign and the Government of Luxembourg.

The 26th African Union (AU) Summit has concluded in Addis Ababa, Ethiopia, under the theme “2016: African Year of Human Rights with a particular focus on the rights of women.”  

Also discussed at the summit was Agenda 2063, a 50-year blueprint for Africa’s development adopted to mark the African Union’s 50th anniversary in 2013. UNAIDS Executive Director Michel Sidibé participated in the summit and met several African leaders, including the Prime Minister of Ethiopia, Hailemariam Desalegn.

Mr Sidibé also held bilateral meetings with the President of Ghana, John Dramani Mahama, the first Lady of Sudan, Wedad Babiker, and the President of the African Development Bank, Akinwumi Adesina.

The meeting closed with a ceremony to thank stakeholders who contributed to the African Union’s response to last year’s Ebola outbreak in western Africa.

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Ahead of the United Nations High-Level Meeting on AIDS, which will take place in New York in June, the Organisation of African First Ladies against HIV/AIDS (OAFLA) has called for the response against the epidemic to be stepped up.   

Meeting in Addis Ababa, Ethiopia, OAFLA First Ladies recognized the huge progress already made in reducing the impact of HIV, but warned against complacency, calling on stakeholders to increase investment in the response. The First Ladies said more resources were required to prevent new HIV infections among children and keep their mothers healthy and alive and to broaden access to testing services. They also said that increased resources were necessary in order to ensure that people access treatment immediately if need be, to allow young people, particularly young women and girls, to access combination prevention services, and to end gender-based violence, which increases the risk of HIV exposure.

Addressing the OAFLA General Assembly, UNAIDS Executive Director Michel Sidibé congratulated the First Ladies for playing a transformative role by championing social justice and keeping the issue of HIV high on the political agenda. He added that achieving zero mother-to-child transmission of the virus, reaching universal health access for children and ending the AIDS epidemic by 2030 were possible if the right decisions were made now.

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UNAIDS Executive Director Michel Sidibé and UNAIDS International Goodwill Ambassador Victoria Beckham have completed a joint visit to Ethiopia to increase awareness about HIV and to underline the need to accelerate the international response to end the AIDS epidemic by 2030.

At the start of their visit, Mr Sidibé and Ms Beckham went to the Alem Children Support Organization, a privately run centre that provides assistance to orphans and underprivileged children affected by HIV, enabling them to access health-care services and attend school.

On the second day, they travelled to the ALERT hospital in Addis Ababa and met mothers, babies and children affected by HIV. During the visit, they also attended a youth group meeting, at which young people come together to lend each other mutual support.

Later, Mr Sidibé and Ms Beckham spent the afternoon at Entoto Beth Artisan, a local business that employs around 120 women living with HIV to make leather goods and traditional jewellery.

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A new book that tells the inspiring stories of 12 mothers living with HIV and their children born free of the virus has been launched at a community event near Polokwane in Limpopo province, South Africa, on the occasion of National Women’s Day (August 9). The book, Faces of an AIDS Free Generation in eastern and southern Africa, aims to promote the further uptake of mother-to-child transmission (PMTCT) services to help prevent the transmission of HIV to children during pregnancy and early motherhood.

In recent years, there has been a rapid scale-up of PMTCT services in the region that has produced significant results. By the end of 2014, an estimated 88% of pregnant women living with HIV in eastern and southern Africa were accessing services to stop them transmitting the virus to their children. This has resulted in a 60% decline in the number of HIV infections among children between 2009 and 2014, from 230 000 to 93 000.

Despite this progress, there is still work to be done to achieve the targets of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. High levels of gender inequality, including gender-based violence and stigma, continue to make it difficult for many women to access sexual and reproductive health care services.

The book highlights the urgent need to further expand PMTCT services to make pregnancy and breastfeeding safer for women living with HIV, as more than 90% of new HIV infections among children occur when women are inadequately supported during pregnancy and early motherhood.

It also stresses the need for the rapid scale-up of paediatric testing and treatment to prevent AIDS-related deaths among children. Without knowing the HIV status of a child it is impossible for them to receive life-saving treatment. Just 38% of children living with HIV in eastern and southern Africa had access to antiretroviral medicines in 2014. Without treatment, half of all children born with HIV will die by the age of two and the majority will die by the age of five.  

Faces of an AIDS Free Generation in eastern and southern Africa is published with the support of the Swedish International Development Cooperation (Sida) and the Norwegian Agency for Development Cooperation (Norad).

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