ECOSOC events are organized in the Economic and Social Council Chamber.
Credit: ECOSOC

The high-level segment of the annual session of the Economic and Social Council (ECOSOC) opened this morning in Geneva with addresses by Sylvie Lucas, President of the Economic and Social Council; Ban Ki-moon, Secretary-General of the United Nations and Hans-Rudolf Merz, President of Switzerland.

The focus of the 2009 Annual Ministerial Review (AMR), which takes place during this high-level segment of ECOSOC will focus on "Implementing the internationally agreed goals and commitments in regard to global public health."

UNAIDS Executive Director Michel Sidibé participated in a session this afternoon on “Partnerships in health – lessons from multi-stakeholder initiatives.”

Mr Sidibé spoke about the prominent role of partnerships in the success of the AIDS response and the importance of collaboration with civil society, faith-based groups and the private sector as “partnerships are the life blood of the AIDS response.”

“People affected by HIV have always been at the heart of the response,” said Mr Sidibé. He also called for a broadened vision, an “AIDS+MDG movement” to address global health and development challenges.

He was joined on the panel by Philippe Douste-Blazy, Special Advisor on Innovative Financing for Development and Chair of the Board of UNITAID Michel Kazatchkine, Executive Director, Global Fund to Fight Aids, Tuberculosis and Malaria.

On Tuesday, Mr Sidibé will participate in a satellite on injecting drug use and a ministerial meeting on AIDS vaccines.

The high-level segment is a forum for Ministers and executive heads of international institutions and high-ranking officials, as well as civil society and private sector representatives to discuss key issues on the international agenda in the area of economic, social and environmental development.

It provides an opportunity to:
1. Assess the state of implementation of the United Nations Development Agenda;
2. Explore key challenges in achieving the international goals and commitments in the area of global public health;
3. Consider recommendations and proposals for action, including new initiatives.

The Economic and Social Council

ECOSOC was established in 1945 under the United Nations Charter as the principal organ to coordinate economic, social, and related work of the 14 UN specialized agencies, functional commissions and five regional commissions. The Council also receives reports from 11 UN funds and programmes. It serves as the central forum for discussing international economic and social issues, and for formulating policy recommendations addressed to Member States and the United Nations system.

The gathering runs until 9 July at the Palais des Nations in Geneva, Switzerland.

The 2009 report of the Global Campaign of the Health MDGs: Leading by Example - Protecting the most vulnerable during the economic crisis.

The United Nations Secretary-General Ban Ki-moon and the Foreign Minister of Norway Jonas Gahr Støre launched the 2009 report of the Global Campaign of the Health MDGs, Leading by Example - Protecting the most vulnerable during the economic crisis. The launch coincided with the High-Level Forum on Advancing Global Health in the Face of Crisis which was held on 15 June at United Nations Headquarters, New York.

The report highlights that recent actions from governments, international agencies and civil society have started to show positive impact on the health of mothers and children. This has given hope for accelerating progress towards the Millennium Development Goals (MDGs) 4 & 5 —aiming to reduce child mortality by two-thirds and maternal mortality by three-quarters by 2015. However, this progress is now threatened by the most severe global economic crisis since the 1930s, especially in low-income countries.

According to the report, more money is needed to accelerate the progress towards the health goals and more specifically to save millions of mothers and their newborn babies.

The Network of Global Leaders, which includes twelve leaders from developing and donor countries, contributed to the report and they urged leaders to take measure to protect the vulnerable, especially women and children, from the economic downturn. "The global economic crisis demonstrates how inter-dependent we have become as a global community. This is the time to honour our commitments and invest in our common future," say the leaders in their signed overview of the report.

The Global Campaign for the Health MDGs was launched by Prime Minister Stoltenberg with other global leaders in New York in September 2007. The aim of the campaign is to increase and sustain the political and financial commitment for the health MDGs, in particular those protecting the most vulnerable, women and children.

The Network of Global Leaders is a group of international leaders that provide political backing and advocacy at the highest possible level for the Global Campaign for the Health MDGs.

UNAIDS Executive Director Mr Michel Sidibé participated in the Forum on African Dialogue where he delivered a presentation on the challenges of pandemics for Africa’s development. Credit: UNAIDS

Africa Day, the official day of the African Union, is observed every 25 May. It is an opportunity to celebrate African diversity and success, but also a time to reflect on the challenges remaining in Africa’s road to development.

To mark the 46th anniversary of Africa Day, the African Union Permanent Representation in Geneva organized the First Forum on African Dialogue which took place on the 27 May 2009, under the theme “Africa’s Development: Whose Responsibility?”

The Chairperson of the African Union Commission (AUC), Mr Jean Ping, officially launched the dialogue forum. The Dialogue brought together representatives of the Swiss government, Ambassadors of permanent missions in Geneva, United Nation Organizations, private sector and other development organizations including the African Development Bank.

UNAIDS Executive Director Mr Michel Sidibé also participated in the forum where he delivered a presentation on the challenges of pandemics for Africa’s development. Mr Sidibé highlighted the role that infectious diseases play in Africa’s underdevelopment. Africa is the region where 11% of the world population live, and is home to 60% of people living with HIV. More than 300,000 children are born every year with HIV when vertical transmission (transfer of HIV from mother to child) has virtually disappeared from most European countries.

“If Africa is to progress with its development, we need to transform health from being Africa’s greatest challenge into being its greatest resource,” said Mr Sidibé. “But we desperately need a pan-African vision on how to get there. We need to engage all partners, from governments to civil society, and development partners, to make a decisive contribution to the health of current and future generations” he added.

Mr Sidibe pointed out that AIDS has shown the need for an institutionalized response in Africa, that is owned and lead by national partners from government and civil society.

During his intervention, Mr Sidibé emphasized the need for a continental vision on how Africa will lead in the response to its epidemics. According to Mr Sidibe, the actions required to transform approaches to health and development are to improve systems for resource management; use human resources effectively; redefine and reorient programmes for research and development to make sure they address Africa’s health priorities; and address trade issues, between Africa and the rest of the world, and within Africa so access to commodities is permanent and sustainable. He called for a greater leadership and mutual accountability to expand universal access to HIV prevention, treatment, care and support to all in Africa.

Ministers of Health of the Association of Southeast Asian Nations (ASEAN) gathered for an informal meeting on the sidelines of the World Health Assembly (WHA) on 19 May 2009 in Geneva, Switzerland.. Credit: UNAIDS/P. Virot

Ministers of Health of the Association of Southeast Asian Nations, or ASEAN, gathered for an informal meeting on the sidelines of the World Health Assembly (WHA) on 19 May 2009 in Geneva, Switzerland.

The main objective of the meeting was to discuss issues of common interest during the WHA, such as ASEAN’s strategies to address the A(H1N1) flu outbreak and prevent a pandemic as well as to discuss with UNAIDS Executive Director Mr Michel Sidibé strategies to achieve universal access to HIV prevention, treatment, care and support.

The meeting was chaired by Honorable Dr Francisco T. Duque III, Secretary of Health of the Philippines and supported by UNAIDS. It was a follow-up to the 2nd ASEAN-UN summit that took place in New York on 13 September 2005. In the New York meeting, participants adopted a Joint Communiqué stating the need for ASEAN members to have a voice in global forums such as the World Health Assembly and participate in global decision-making regarding allocation of funds for HIV prevention and control.

Mr Michel Sidibé, Executive Director of UNAIDS and Under Secretary-General of the United Nations presented his vision to the ASEAN countries and restated UNAIDS’ commitment to support countries in achieving universal access.

Mr Michel Sidibé, Executive Director of UNAIDS and Under Secretary-General of the United Nations presented his vision to the ASEAN countries and restated UNAIDS’ commitment to support countries in achieving universal access.

Mr Sidibé also outlined how a number of countries in the region have made significant progress in ensuring that the most vulnerable communities, including sex workers and their clients, men who have sex with men and injecting drug users, are a priority in national AIDS responses.

Mr Sidibé underscored the importance of government leadership in order to achieve the universal access targets and praised the commitment demonstrated by the ASEAN countries in responding to the AIDS epidemic as seen in their adoption in 2007 of the ASEAN Declaration on HIV and AIDS and the Declaration on the Protection and Promotion of the Rights of Migrant Workers.
At the end of the meeting, Health Ministers produced a Joint-ASEAN Ministerial Statement on ASEAN’s position in pandemic preparedness for avian, human and A(H1N1) influenza, particularly on cross-border collaboration, sharing of information and  viral specimens, and universal access on HIV prevention, treatment, care and support.

Photo (60th WHA)
Credit WHO/Peter Williams

This year’s World Health Assembly is set to focus considerable attention on the widespread outbreak of influenza A(H1N1), as Health Ministers and officials of more than 190 countries gather in Geneva from 18-22 May to discuss the most effective responses to the potential pandemic, including preparedness, access to vaccines and sharing of influenza viruses.

According to the latest World Health Organization (WHO) statistics, there are now 39 countries reporting a cumulative total of 8480 cases of A(H1N1) (17 May update). The virus represents a serious and growing health threat. WHO Director-General Dr Margaret Chan has called for “global solidarity” in the face of this unpredictable threat and the sixty-second World Health Assembly will provide an opportunity for such solidarity.

The World Health Assembly, convened by the Director-General of the World Health Organization, will also follow its broad remit to review progress and set new priorities for the WHO. Other issues to be examined will include primary health care and health system strengthening; exploring the social determinants of health and monitoring the achievement of the health-related Millennium Development Goals. There will also be room for the discussion of the programme budget for the next two years and internal management matters.

A key element of the meeting is the consideration of the revised version of the Medium-term strategic plan 2008-2013 which has 13 objectives including the reduction of the health, social and economic burden of communicable disease; mitigating the health consequences of emergencies, disasters, crises and conflicts; ensuring improved access, quality and use of medical products and technologies, and challenging the spread of AIDS, tuberculosis and malaria.

Delegates hope to build on the success of previous meetings. For example, in 2008 the assembly endorsed a public health, innovation and intellectual property strategy which promoted new approaches to drug research and development and championed the removal of barriers, enhancing access to medicines, especially for less developed nations. The gathering also adopted a resolution urging Member States to take decisive action to address the health impacts of climate change.

It is clear that the World Health Assembly is expected to explore a complex array of issues that transcend the sphere of health, touching on and interconnecting with a broad range of other sectors with the aim of mounting an effective challenge to global health threats.

During the week, UNAIDS Executive Director Michel Sidibé will participate in a range of side events including meetings with national ministers of health from around the world.

Cultural sensitivity is critical for the success of development strategies according to a new report produced by the United Nations Population Fund (UNFPA). Credit UNFPA

Cultural sensitivity is critical for the success of development strategies according to a new report produced by the United Nations Population Fund (UNFPA). Reaching Common Ground: Culture, Gender and Human Rights, launched 12 November 2008, reports that culture is a central component of successful development of countries, and must be integrated into development policy and programming.

The State of World Population 2008 report affirms that development strategies that are sensitive to cultural values can reduce harmful practices against women and promote human rights, including gender equality and women’s empowerment.

Despite many declarations and affirmations in support of women’s rights, the report argues, gender inequality is widespread and deep-rooted in many cultures. Coercive power relations underlie practices such as child marriage - a leading cause of obstetric fistula and maternal death—and female genital mutilation or cutting. These and other harmful practices continue in many countries despite laws against them.

Gender inequality and HIV

The effects of gender inequality leave women and girls more at risk of exposure to HIV. Less access to education and economic opportunities results in women being more dependent on men in their relationships, and many who have no means of support must resort to bartering or selling sex to support themselves and their children. Where women can’t own property and lack legal protections, their dependence within their families is even greater. Economic and social dependence on men often limits women's power to refuse sex or to negotiate the use of condoms.

The report, which coincides with this year’s 60th anniversary of the Universal Declaration of Human Rights, is based on the concept that the international human rights framework has universal validity. Human rights express values common to all cultures and protect groups as well as individuals. The report endorses culturally sensitive approaches to the promotion of human rights, in general, and women’s rights, in particular.

Culturally sensitive approaches call for familiarity with how cultures work, and how to work with them. The report suggests that partnerships - especially with community-based institutions and leaders - can create effective strategies to promote human rights and end their abuses, such as female genital mutilation or cutting, wife inheritance or rape within marriage.

“Communities have to look at their cultural values and practices and determine whether they impede or promote the realization of human rights. Then, they can build on the positive and change the negative,” said Thoraya Ahmed Obaid, Executive Director of UNFPA

Therefore, The State of World Population report cautions that cultural sensitivity and engagement do not mean acceptance of harmful traditional practices, or a free pass for human rights abuses. Values and practices that infringe human rights can be found in all cultures. Understanding cultural realities can reveal the most effective ways to challenge these harmful cultural practices and strengthen beneficial ones.

The report concludes that analysing people’s choices in their local conditions and cultural contexts is a precondition for better development policies.

The Clinton Global Initiative (CGI) is a
non-partisan catalyst for action that brings
together a community of global leaders
from various backgrounds to devise and
implement innovative solutions to some
of the world’s most pressing challenges.

The annual meeting of the Clinton Global Initiative (CGI) concludes today in New York. The three-day event brought together a diverse group of world leaders from government, business, international agencies and civil society to examine global challenges and transform that awareness into action.

UNAIDS Executive Director Dr Peter Piot and former President of the Portuguese Republic, Jorge Sampaio participated in a working group breakfast on global health which addressed AIDS, tuberculosis, and malaria.

Increased effort and investment in the AIDS response in recent years have yielded examples of successful approaches that can be replicated or scaled up globally. The participants identified and explored opportunities to improve the way we respond to these diseases with existing tools and knowledge and highlighted current challenges.

Since its inception in 2005, CGI has convened a community that includes more than 80 current and former heads of state, hundreds of business, international and non-profit leaders, major philanthropists, and Nobel Peace Laureates. Their aim is to devise and implement innovative solutions to some of the world’s most pressing challenges.

The 2008 Annual Meeting focussed on challenges and opportunities in the following four focus areas: education, energy and climate change, global health and poverty alleviation.

The Global Campaign for the Health MDGs: First year report 2008.

A group of global leaders met in New York on 26 September 2007 to launch the Global Campaign for the Health Millennium Development Goals (MDGs). The Campaign aims to give renewed impetus to Goals 4, 5 and 6 which focus on the urgent need to improve maternal, newborn and child health and to combat HIV/AIDS, malaria and other diseases.

To mark the first year of the Campaign, a progress report was released on 25 September. It provides an update of major activities during the last year, and highlights concrete actions that are required to accelerate the necessary progress if we are to reach the health related MDGs by 2015.

Read the contribution by Dr Peter Piot, Executive Director, UNAIDS:

Scaling up towards Universal Access: AIDS, Malaria, Tuberculosis and Immunization

AIDS is inextricably linked to the other MDGs: education, gender equality and poverty eradication are all vital for fighting it. And in many countries reducing HIV infections and deaths from AIDS is essential for making progress on other MDGs.

By the end of 2007, the global number of new HIV infections and AIDS-related deaths had begun to decline – largely the result of action on political commitments. At the G8 summits in 2005 and 2008, and at the UN High-Level Meeting on HIV/AIDS in 2006, leaders agreed to scale up to universal access to HIV prevention, treatment, care and support by 2010.

There are now 105 countries with national targets for universal access, and 147 countries submitted progress reports this year. In 2007, investment in HIV programmes reached US$10 billion, up from US$8.3 billion in 2005. Extraordinary efforts resulted in three million people in low- and middle-income countries receiving anti-retroviral treatment in 2007 – a million more than in 2006.

Several heavily affected countries are making progress on HIV prevention. There are falls in the number of people having more than one partner in the last year, increases in condom use among promiscuous young people, and, in sub-Saharan Africa, signs that people are beginning to have sex at a later age.

Access has improved to antiretroviral drugs that prevent mother-to-child transmission (PMTCT) of HIV. In low- and middle-income countries, a third of women who need the drugs can get them – up from 14% in 2005. Some countries, including Argentina, Botswana, Georgia and the Russian Federation, have achieved close to universal access, with PMTCT services at more than 75% coverage. In Botswana, just 4% of children born to HIV-positive mothers are infected.

Other prevention efforts are also improving. Of 39 countries reporting on it, coverage of HIV-prevention services for sex workers is 60%. For people who inject drugs coverage is nearly 50% in 15 countries, and for men who have sex with other men it is 40% in 27 countries.

In many countries AIDS programmes are supporting fragile health systems, improving service delivery, staff, information systems, governance and the procurement and management of drugs. We recommend using a third of HIV/AIDS resources to strengthen health systems.

There is more to do. In low- and middle-income countries, two-thirds of people requiring antiretroviral drugs cannot get them. For every two people starting HIV treatment, five become infected. AIDS remains the biggest killer of African adults (25-49) and is among the top ten killers worldwide. Like climate change, AIDS will require a long-term response. We need to build on progress and strengthen links with other health programmes, notably tuberculosis, sexual and reproductive health, and maternal and child health.

This will require more money: over 50% more by 2010 to maintain the current pace of growth in prevention and treatment. The price is worth paying.

Peter Piot
Executive Director
UNAIDS

(from left) Dr. Peter Piot, Executive Director
of UNAIDS; Julian Lob-Levyt, Executive
Secretary of the Global Alliance for Vaccines
and Immunization (GAVI); Dr. Tedros
Adhanom, Minister of Health, Ethiopia;
Andrew Jack, Financial Times Pharmaceuticals
Correspondent; Michel Kazatchkine,
Executive Director of the Global Fund;
Ann Veneman, Executive Director of
UNICEF participate in MDG HLM side
event on MDG 6 equity challenge.
23 September, UNHQ, New York.
Credit: UNAIDS/Brad Hamilton

In 2000, global leaders embraced a series of Millennium Development Goals (MDGs) that resolved to make the world safer, healthier, and more equitable.

We are half-way to the 2015 target date and progress is mixed and uneven. To assess the gaps and understand what more needs to be done to ensure nations are on course to achieve the commitments they have made, a High-level Event on the MDGs takes place on 25 September 2008 hosted by the United Nations Secretary-General and the President of the General Assembly.

MDG 6 and universal access to HIV prevention, treatment, care and support by 2010

MDG 6 aims that by 2015 the world will have halted and begun to reverse the global HIV epidemic.

UN Member States have also committed, in a Political Declaration at the General Assembly in 2006, to taking extraordinary action to move towards universal access to HIV prevention, treatment, care and support by 2010. At this juncture it is useful to assess the HIV response.

Dr. Peter Piot, Executive Director of UNAIDS
speaks at MDG HLM side event on MDG
6 equity challenge. 23 September, UNHQ,
New York. (right) Julian Lob-Levyt, Executive
Secretary of the Global Alliance for Vaccines
and Immunization (GAVI)
Credit: UNAIDS/Brad Hamilton

Although Goal 6 specifically addresses the HIV epidemic, an effective HIV response will also support achievement of other Millennium Development Goals. Success in the achievement of the MDGs will also make an impact on HIV epidemics around the world. Addressing the obstacles to universal access to HIV prevention, treatment, care and support services will contribute to the achievement of the broader MDGs. These include addressing stigma and discrimination, human rights and gender inequality as well as ensuring sustainable financing, affordable commodities, strengthened health systems and human resources, and accountability.

MDG 1: Eradicate extreme poverty and hunger.

There is a complex relationship between AIDS, poverty and human development, a so-called ‘vicious circle’ within which the impacts of AIDS increase poverty and social deprivation, while socio-economic inequalities increase vulnerability to HIV infection.

With the eradication of extreme poverty and hunger, people may reconsider lifestyle options which put them at higher risk of HIV such as working far away from home or in commercial sex.

Especially in high-prevalence settings, HIV deepens household poverty and slows economic growth. Alleviating the epidemic’s burden helps countries to grow their economies, reduce income inequalities, and prevent acute hunger. In Western Kenya, antiretroviral treatment has led to a large and significant increase in the labour supply. Within six months of starting treatment there is a 20% increase in the likelihood of participating in the labour force, and a 35% increase in weekly hours worked. This brings economic and other benefits to the family including for children’s nutritional status.

MDG 2: Achieve universal primary education.

The HIV response promotes universal education initiatives. Ensuring children’s access to school is an important aspect of HIV prevention, as higher levels of education are associated with safer sexual behaviours and delayed sexual debut and reduce girls’ vulnerability to HIV.

School attendance is a central focus of initiatives to address the needs of children orphaned or made vulnerable by HIV. Better access to treatment helps to minimize the epidemic’s impact on fragile educational systems; it also reduces the likelihood that young people will be withdrawn from school in response to HIV in the household.

MDG 3: Promote gender equality and empower women.

The effects of gender inequality leave women and girls more at risk of exposure to HIV so progress in this Goal is of fundamental importance to the HIV response.

Less access to education and economic opportunity results in women being more dependent on men in their relationships, and some who have no means of support must resort to bartering or selling sex to support themselves and their children. Where women cannot own property and lack legal protections, their dependence within their families is even greater.

The HIV response itself is also helping to drive efforts to reduce inequalities between the sexes. Countries are now monitored on the degree to which gender equity is a component of national HIV responses. Thus, the epidemic has increased the urgency of initiatives to forge new gender norms, and extensive worldwide efforts are under way to develop new HIV prevention methods that women may initiate. HIV has prompted parents, communities, and governments alike to approach the sexual and reproductive health needs of women, girls, and sexual minorities with renewed commitment.

MDG 4: Reduce child mortality.

Deaths due to AIDS among children is declining since 2003 as there is a drop in new infections and more children being put on treatment. However in most-affected countries such as Botswana and Zimbabwe, more than one third of all deaths in children under 5 are due to AIDS.

A key component of a comprehensive HIV response is the scaling up of prevention strategies that can nearly eliminate the risk of mother-to-child HIV transmission.

MDG 5: Improve maternal health.

Women now account for about half of all people living with HIV, and for more than 60% of infections in Africa. Greater access to antiretroviral medicines is improving the health and well-being of women, and pre-natal programmes for preventing mother-to-child transmission help mothers remain in good health to care for their children.

Integration of HIV initiatives with programmes addressing sexual and reproductive health is helping to ensure that women have access to the information and services they need to make informed reproductive decisions.

MDG 6: Combat HIV/AIDS, malaria, and other diseases.

Progress in TB control will greatly benefit the AIDS response as TB, which is mostly curable and preventable, is one of the most important causes of illness and death among people living with HIV.

A strong HIV response yields health benefits that extend well beyond HIV itself. The push to expand access to HIV treatment in resource-limited settings is helping to strengthen fragile health infrastructures and is driving improvements in human capacity in low- and middle-income countries.

MDG 8: Develop a global partnership for development.

Perhaps more than any other issue in our time, HIV has highlighted global and economic inequities, and has galvanized action on international development. HIV has helped place people at the centre of development.

Progress on inclusive, country-owned development strategies will deliver greater success for improved aid effectiveness, strengthened health systems and the AIDS response.

The AIDS response has championed more inclusive partnerships as being key and has pioneered the principle of country ownership through the 'three ones'.

High-level Event on the MDGs: Side events

UNAIDS Secretariat, its cosponsors and partners will host the following side events in relation to MDG 6:

The MDG 6 equity challenge
Organized by the Mission of Ethiopia, UNAIDS, Global Fund to Fight AIDS, TB and Malaria, and the Global Alliance for Vaccines and Immunization (GAVI). The meeting will focus on achieving MDG 6 by increasing access to basic health services, especially the delivery of new health technologies to geographically and socially marginalized communities.

UN system coherence to achieve MDG 6
Organized by the Missions of Ireland and Tanzania, UNAIDS, and UN Development Operations Coordination Office. The meeting will highlight coordination mechanisms to promote and enhance system wide support of national priorities to achieve MDG 6.

The AIDS response: Relationship to development in Africa

As high-level participants and international experts gather to discuss Africa’s development needs and challenges at UN headquarters in New York on 22 September, we take a look at how HIV and the AIDS response is impacting development on the continent.

In countries in Africa most heavily affected by HIV, the epidemic has reduced life expectancy by more than 20 years, slowed economic growth and deepened household poverty. However effective, sustainable AIDS responses offer an opportunity to overturn the critical development challenges to overcoming poverty, improving education, extending life expectancy and reducing child mortality.

Development needs leveraged through AIDS leadership

When committed national leadership on AIDS is combined with long-term coordinated financing, dividends beyond the epidemic are being seen in Africa. Scaling up HIV services means addressing years of under-investment in health human resources in resulting in strengthened health systems which lead to improved maternal and child health. As individuals benefit from antiretroviral treatment, they live longer and their labour productivity rises, lifting households from poverty and improving food security for their families.

“How we fare in fighting AIDS will impact all our efforts to cut poverty and improve nutrition, reduce child mortality and improve maternal health, curb the spread of malaria and tuberculosis.” - United Nations Secretary-General Ban Ki-Moon speaking at the General Assembly High Level Meeting on HIV/AIDS, New York, June 2008

In addition, an AIDS response that addresses deep seated drivers or causes of vulnerability to HIV infection—stigma, discrimination, gender inequality and human rights—will impact wider development.

Successes and progress

Affected countries in Africa are showing strengthening leadership in addressing challenges by increasing the use of their own resources. The per capita domestic public HIV expenditure (from governments’ own sources) in sub-Saharan Africa was six times greater than other parts of the world after adjusting by income level (2008 Report on the global AIDS epidemic).

The substantial increases in AIDS funding and the investment in prevention and treatment of recent years are producing encouraging results in a number of countries in Africa.

In Rwanda and Zimbabwe changes in sexual behaviour—waiting longer before becoming sexually active, having fewer multiple partners, increased condom usage among people with multiple partners—have been followed by declines in the number of new HIV infections. Condom use is increasing among young people with multiple partners in Benin, Burkina Faso, Cameroon, Chad, Ghana, Kenya, Malawi, Namibia, Uganda, Tanzania and Zambia.

HIV epidemics in Malawi, South Africa and Zambia appear to have stabilized and most of the comparatively smaller HIV epidemics in West Africa are stable or are declining, as is the case for Burkina Faso, Cote d’Ivoire, Mali and Nigeria. HIV prevalence in HIV epidemics in East Africa have either stabilized or are receding.

Gains in access to antiretroviral treatment

More people have access to HIV treatment than ever before. Of the 3 million people who received HIV treatment in 2007, more than 2 million of them are in sub-Saharan Africa. In the period 2003 to 2007, Namibia scaled up treatment from 1% to 88%, Rwanda from 3% to 71%. As a result we’ve seen number of AIDS-related deaths decline over the past two years from 2.2 million to 2 million in 2007.

This is paying incalculable dividends for African countries. HIV treatment means that HIV-positive people are living longer, in better health and with a higher quality of life. They can continue to be productive within their workplace and community and there is less risk of their household falling into poverty and food insecurity.

Good progress has also been made in the prevention of mother-to-child transmission of HIV with increases in coverage of services in countries including Botswana, Namibia, Swaziland and South Africa.

This progress suggests a return on the investments made on different fronts, particularly in HIV prevention and treatment, and shows that with continued commitment, countries can overcome the development challenge that the epidemic poses.

Demographic impact of HIV

However, in spite of successes the epidemic continues to outstrip the response. The 2008 report on the global AIDS epidemic released by UNAIDS shows that AIDS continues to be the leading cause of death on the continent of Africa. In southern Africa, the average life expectancy at birth is estimated to have declined to levels last seen in the 1950s—below 50 years for the sub-region as a whole.

The numbers are stark: 67% of all people living with HIV and almost 90% of children living with HIV are in sub-Saharan Africa. In Botswana and Zimbabwe more than one third of all deaths in children under 5 are due to AIDS.

Progress, but gaps remain

As pointed out in the UN Secretary-General’s Report to the June 2008 High-level meeting on AIDS, countries need to sustain the progress that they have already made and continued leadership is required for the implementation of fully funded and sustainable national strategies and programmes on HIV.

HIV: A public health and a development issue

HIV is both a public health and a development issue which requires a sustained, inclusive and multi-sectoral response.

The Commission on HIV/AIDS in Africa (CHGA) issued a report earlier this year which included a call for leadership at all levels to be mobilized and coordinated for a concrete HIV response and broader development plan. The report also calls for addressing gender inequalities in national strategies as 60% of people living with HIV in sub-Saharan Africa are women.

High-level meeting on Africa’s development needs

At the high-level meeting on Africa’s development needs taking place in New York on 22 September, heads of State or Government, ministers as well as civil society organizations, intergovernmental organizations, UN agencies, funds and programmes, as well as the Bretton Woods institutions will gather to discuss “Africa’s development needs: State of implementation of various commitments, challenges and the way forward.” The meeting will conclude with the adoption of a Political Declaration. UNAIDS Secretariat, its cosponsors and partners will host a series of side events.