The countries of the South are shifting the global power balance with massive strides in economic growth, poverty reduction, education and health.

The world is changing rapidly with developing nations spearheading global economic growth, impressive poverty reduction and the rise of a healthier, better educated middle class, says the UN Development Programme’s (UNDP) Human Development Report 2013.

According to the publication, The Rise of the South: Human Progress in a Diverse World, this rise is “unprecedented in its speed and scale. Never in history have the living conditions and prospects of so many people changed so dramatically and so fast.” 

The momentum of such achievements in poverty reduction, education, income and tackling health issues like HIV, is increasing. It can be seen as an overdue “global rebalancing” with new actors “shaping the development landscape” and gaining in political and economic influence.  

There has been notably rapid progress in more than 40 countries of the South—traditionally referred to as developing nations—whose advancement has been markedly better than expected, the report notes. Coming from all continents and ranging widely in size, they include:  Bangladesh, Brazil, Chile, China, Ghana, India, Mexico, Rwanda, Uganda and Vietnam.  Uganda, for example, through a series of economic, health, education and social measures, has managed to halve extreme poverty before the Millennium Development Goal deadline of 2015. It fell from 56% in 1992-93 to 25% in 2009-10.

The report was launched in Mexico City on March 14 by the UNDP’s Administrator Helen Clark and Mexican President Enrique Peña Nieto.  As well as an extensive analysis of original research, it also contains an updated Human Development Index which measures the progress of nations in terms of health, education and income. In addition, the publication contains data on the critical gender aspect of development in its Gender Inequality Index which shows that despite serious inequities persisting, there has been progress in equality almost everywhere.

As with general development, the pace of success in the AIDS response is quickening in an unprecedented way. The 2012 UNAIDS global report showed that the rate of infection across 25 low- and middle-income countries has been cut by half.

The accelerated development of the South is critical to the success of the global AIDS response as the most heavily burdened countries are low-and middle income. UNAIDS maintains that getting to zero new infections, zero discrimination and zero AIDS-related deaths will need advances not only in the sphere of health and HIV but in terms of poverty reduction, education, gender equality and enhanced life opportunities

Image of one of the promotional images of the campaign featuring the Carnival queens.
Credit: UNAIDS

Last week was Carnival in Panama.  As part of the celebrations during 11-12 February, the Queens of “Calle Arriba” and “Calle Abajo” —representing opposite neighbourhoods— competed against each other in a variety of contests. However when it comes to HIV, the two rivals joined forces to prevent new HIV infections among women.

UNAIDS, in partnership with the Panamanian Carnival Boards of “Calle Arriba” and “Calle Abajo”—the national institutions in charge of planning and coordinating activities related to this festivity— the National AIDS Programme, and PROBIDSIDA, launched a national campaign entitled “I decide, I take care of myself” (Yo decido, yo me cuido).

The campaign, which will run until the end of February, aims to help reduce gender inequalities, empower women and promote sexual and reproductive rights. One of the major goals is to ensure women can make informed decisions in relation to their sexual health, especially when it comes to preventing HIV.

“If we want that no more women get infected with HIV in Panama we need to join efforts at all levels, including institutions, civil society organizations and international agencies. This is why we decided to endorse this initiative,” said Pilar De Amores, Legal Representative of “Calle Arriba” Carnival Board.

In the last decade the number of new HIV infections has been on the rise among young women in Panama. A national survey on sexual and reproductive health held in 2009 and 2010 found that only 9% of women use condoms as a preventive measure during sex. Gender inequality is a major driving force behind the lack of reproductive and sexual rights of women in the country.

“Gender inequalities affect women´s power to insist on and negotiate safe sex practices like condom use, and thus protect themselves from HIV” explains Ricardo Garcia, UNAIDS Country Coordinator for Panama and Costa Rica. “We have created this campaign to increase the recognition of women as having sexual rights and capable of exercising them, in line with the UNAIDS action framework on women, girls, gender equity and HIV”.

The campaign includes television spots that are being broadcast on national networks as well as posters in schools, organizations and on the streets featuring the Carnival queens calling on Panamanian young women to take the lead and protect themselves from HIV.  As part of the campaign, the Queens received special training on issues related to HIV prevention and gender inequalities, in order to participate in public events and media programmes promoting the campaign.

“Women need access to HIV information, education, and services to have control over our bodies and be able to negotiate the use of condoms with our partners,” said Maruquel Madeleine González Velásquez, Queen of “Calle Arriba”. “I feel extremely accomplished to be part of this project,” she added.

Under the revised penal code young people between the age of 14 and 18 years old will be able to exercise their sexual and reproductive rights.
Credit: UNAIDS

The Constitutional Tribunal of Peru is amending an article in its penal code which for many years had criminalized consensual sexual activity among young people. Sentencing was particularly severe with adolescents facing up to 30 years in prison. Article 173 of the penal code was also preventing young people from accessing essential health and reproductive services for fear of prosecution.

Under the revised penal code young people between the age of 14 and 18 years old will be able to exercise their sexual and reproductive rights providing the two parties are consenting. Non-consensual sexual relations will still constitute a crime in Peru with lengthy sentencing for people found guilty.

"The Constitutional Tribunal ruling generates a protective effect in relation to adolescents, because it provides them with greater access to sexual and reproductive health services as well as guidance and information to avoid sexually transmitted infections, including HIV," said Mima Barnechea from the United Nations Population Fund (UNFPA).

In 2012, UNFPA and UNAIDS presented a formal request before the Constitutional Tribunal advocating for the declaration of unconstitutionality of Article 173.  This process was part of a wider effort particularly from the Office of Peru’s Ombudsman, Eduardo Vega Luna as well as legal demands presented before the Tribunal by more than 10 000 Peruvian citizens.

"UNAIDS welcomes the Constitutional Tribunal’s decision and congratulates the magistrates for their determination to protect adolescents’ human rights,” said UNAIDS Coordinator for Peru and Bolivia, Regina Castillo. “The Tribunal’s decision reinforces young people’s right to make decisions regarding their health and sexuality and the need to construct policies and programmes that recognize young people as active actors of change.”

According to a National Demography and Health Survey of 2011 a large percentage of Peruvians initiate sexual relations before the age of 18.  More than 12% of female adolescents (ages between 15 and 19) have been pregnant at least once.

"This decision is a milestone that sets the basis for plans and programs at national level to prevent teen pregnancy and reduce sexually transmitted infections including HIV and maternal mortality," said Carlos Tacuri Calderon, youth activist in Peru and member of INPPARES.

UNAIDS estimates that around 74 000 people are living with HIV in Peru of which approximately half became infected before the age of 20. This situation stresses the need to raise awareness on HIV and its modes of transmission among teenagers. In December 2012, the Ministry of Health in collaboration with UNAIDS and other partners launched the campaign “take an HIV test––it’s better to know” which aimed to reach young men with key HIV prevention messages and provided free HIV tests.

Vice-Minister of Health José del Carmen Sara launching the campaign “It is better to know: Get an HIV test.”

In the lead up to this year’s World AIDS Day, the Ministry of Health of Peru in collaboration with Asociación Dignidad, UNAIDS and the Pan American Health Organization (PAHO), launched the campaign “It is better to know: Get an HIV test.” The initiative aims to increase HIV testing coverage in the country, particularly among men, by providing free HIV tests.

Men aged 18 to 25 years are the main focus of the campaign, which aims to test 10 000 people by 1^st December (World AIDS Day). The testing will take place in 16 different venues set up by the Ministry, including in various universities, in order to reach as many young men as possible.

“This is an effort by the Ministry of Health to make HIV testing more accessible for men,” said Vice-Minister of Health José del Carmen Sara during the event.

There are 74 000 people living with HIV in Peru, 77% of whom are men. 56% of new infections occur in men who have sex with men and 9 out of 10 women acquire HIV from their stable partners, who may engage in high-risk behavior such as buying sex or having sex with other men. It is estimated that half of the people living with HIV in Peru were infected before the age of 21.

Although men are at higher risk of HIV infection than women, their access to health services has traditionally been poorer. Despite the fact that 3 of 4 people living with HIV are men, only 7% of men reported having been tested for HIV in 2008. Increased testing would provide greater opportunities for HIV prevention and early treatment.

Peru introduced rapid HIV testing and counseling for pregnant women in 2006, and in 2008 a large scale HIV testing and counseling campaign was organized focusing on women of reproductive age. In the same year the Ministry of Health also increased access to HIV testing and counseling for men who have sex with men, transsexuals and sex workers, but so far HIV tests have only been free for women.

“Half of the people living with HIV in Peru do not know their HIV status. It is important to save lives by increasing access to both HIV diagnosis and treatment,” said Regina Castillo, UNAIDS Country Coordinator for Peru and Bolivia.

The launch on November 21^st brought together people living with HIV, UN representatives, government officials, journalists, international organizations, and renowned artists, including entertainer and HIV activist Ernesto Pimentel and singer Eva Ayllon.

L to R: Luiz Loures, UNAIDS Director of the Political and Public Affairs branch; César Antonio Núñez, Director of the Regional Support Team for Latin America; Dr Carissa Etienne, Director elected of the Pan American Health Organization; Michel Sidibé, Executive Director of UNAIDS; and Ernest Massiah, Director of the Regional Support Team for the Caribbean.

UNAIDS Executive Director Michel Sidibé met on 7 November with the recently appointed Director of the Pan American Health Organization (PAHO) Dr Carissa Etienne at the UNAIDS Headquarters in Geneva to strengthen collaboration towards putting an end to AIDS in the Americas.

"We can build on the successes of the Americas, a region that was one of the first to eliminate measles and polio,” said Mr Sidibé. “There is no reason why this region cannot be the first to end AIDS.”

During the meeting, they exchanged ideas on how to increase joint efforts to achieve the Millennium Development Goals by 2015 and to ensure that health and HIV are part of the post 2015 agenda.

"As we look forward, HIV and health are key for the region, and for global development,” said Dr Etienne. “PAHO will play a key role in moving this agenda forward and with UNAIDS, the Americas can be the first region to see the end of AIDS.”

Dr Carissa Etienne, a native of Dominica, was elected as the new PAHO Director during the 28th Pan American Sanitary Conference that took place from 17-21 September 2012 in Washington D.C. and will begin her five-year term on 1 February 2013. Dr Etienne is currently Assistant Director General, Health Systems and Services, of the World Health Organization (WHO) in Geneva.

UNAIDS Executive Director Michel Sidibé and the Minister of Health of Costa Rica, Dr Daisy Corrales. UNAIDS HQ, Geneva. 6 November 2012. Credit: UNAIDS

The Minister of Health of Costa Rica, Dr Daisy Corrales, aims to strengthen the AIDS response among key populations at higher risk in her country, which is where the epidemic remains concentrated. During a meeting with UNAIDS Executive Director Michel Sidibé on 6 November at the UNAIDS Headquarters in Geneva, Dr Corrales highlighted the focus of her Ministry in developing HIV communications and educational strategies for organizations working with male sex workers.

“We need to develop our strategies to reach male sex workers with HIV information and education that is relevant to their needs and in agreement with their particular work schedules,” said Dr Corrales.

Costa Rica’s HIV prevalence among adults 15 to 49 years of age is 0.3%. The country’s HIV epidemic is concentrated among key populations at higher risk of infection such as the migrant indigenous population, men who have sex with men (MSM), sex workers and their clients. A study conducted in 2010 found HIV prevalence among MSM of 10.9% and 11% among female sex workers.

“It is not always easy to talk about men who have sex with men, sex workers or drug users but we have an obligation to ensure they have access to HIV services that are free from stigma and discrimination,” said Mr Sidibé.

Mr Sidibé also commended the Government of Costa Rica for its efforts in scaling up HIV treatment for people with HIV—an estimated 65% coverage—as well as their success in stopping new HIV infections among children. “Costa Rica’s transmission rate of HIV from mother-to-child is consistently under 2%, a very impressive feat and a bold example for Latin America that an HIV free generation is within our reach.”

Mr Sidibé assured the Minister of Health that UNAIDS will continue providing support to Costa Rica to design its strategy for an effective and sustainable response to AIDS.

The Network of Positive Youth for Latin America and the Caribbean has launched a regional consultation for young people living with HIV. The aim of the consultation is to obtain information on the realities that young people living with HIV face in their everyday lives in order to develop new and more effective HIV strategies focused on their specific needs.

The consultation tool, developed with support from UNAIDS, UNICEF and UNFPA, consists of an online and confidential survey of roughly 40 questions that focuses on young people aged 18 to 29 years old and living with HIV from 17 Latin American and two Spanish-speaking Caribbean countries. The online platform is designed to run on any computer and has a special program to facilitate access from mobile devices.

The tool will collect information related to the socio-demographic aspects of young people living with HIV, their access to health services, experiences with stigma and discrimination, and their leadership and community participation. Young people living with HIV will be able to participated in the survey until 30 November 2012 at the following website: http://consulta.jovenespositivos.org

“Usually, positive youth remain invisible to research and data collection exercises.  This consultation is an opportunity to make our voices heard,” explained Mariana Iacono, a founding member of the Network of Positive Youth. “To be able to develop HIV strategies and programs that meet our needs we must know our situation, needs and realities in our communities.”

A team of young people from the Network of Positive Youth will analyze the results of the online consultation and will design a short and long term action plans for the region. The results will also serve as advocacy tools to demand the development of national strategies that focus on the needs of young people living with HIV. “We know that sometimes it is difficult to share feelings and memories, but we believe it is from our own experiences that we can bring new ideas and solutions to address HIV in a more inclusive and cost effective way,” said Pablo Aguilera, member of the Network.

In Latin America, an estimated 68 000 adolescents (10-19 years) are living with HIV. Of these, 34 680 are women. In 2011, 34 440 new HIV infections occurred among young people between 15 to 24 years, accounting for 41% of all adult HIV infections. “A generation of young people born with HIV is growing up with its specific needs being largely neglected,” noted Mark Connolly, UNICEF Senior Adviser for Latin America and the Caribbean. In 2011, an estimated 2 000 children were born with HIV in the region.

As young people living with HIV transition from childhood through adolescence to young adulthood, they face a range of specific needs, including accessing treatment, tackling stigma and discrimination, and accessing youth-friendly integrated HIV and sexual and reproductive health services. “Young people living with HIV are a heterogeneous group, with diverse populations that needs urgent attention in many areas, especially those who are more affected by stigma and discrimination, such as transgender, gays and drug users,” said Cesar A. Núñez, UNAIDS Regional Director for Latin America. 

The UNFPA Regional Director for Latin America and the Caribbean, Marcela Suazo emphasized that the epidemic on positive young people is worsened because of social exclusion, as well as gender inequality, stigma and discrimination related to HIV. “It is necessary to ensure a human rights platform that extends strongest non-discriminatory access of young people to education, counseling and adequate sexual and reproductive health," she said.

In Latin America, a new wave of youth-led community mobilization is emerging, advocating for human rights and demanding access to HIV services. The Regional Network of Positive Youth is organizing youth to participate in decision-making and consultation spaces beyond national spheres. In December 2012, the Network is organizing the first regional meeting of young people to define coordinated actions across the region, enhance leadership and mobilization towards meeting the global targets for 2015.

Ecuadorian children attending school

The government of Ecuador, under the leadership of President Rafael Correa, recently approved a new public policy aimed at the protection of children living with HIV. The new policy will also complement efforts to eliminate new HIV infections among children in the country.

The policy states a monthly distribution of a cash transfer, using public health structures, to the caregivers of children under the age of 14 living with HIV. The government estimates that in the first year, caregivers of 500 children will fulfill the criteria to receive the cash transfer.

Vice-President Lenin Moreno, who initiated the proposal of the new policy said: “With this programme we are setting a milestone for social protection in Latin America. The cash transfers give children living with HIV continued access to treatment, which will improve their health and ensure that they are able to move forward with their lives.”

The value of the grant is a monthly allocation of US$ 240 and it has to be used by caregivers in order to improve living conditions of the children, reversing malnutrition and expanding their access to education, health and HIV related services. The transfer is conditional to the children’s attendance to school and regular health check‐ups.

“UNAIDS salutes this important initiative, which is a benchmark for other countries in the social protection of children and families affected by HIV," said César A. Núñez, UNAIDS Regional Director for Latin America.

The Ministry of Health and local hospitals together with community based organizations and civil society networks will identify eligible children, ensure proper coverage of HIV treatment and monitor the children’s regular attendance to health facilities. The Ministry of Social and Economic Inclusion (MIES) will oversee the implementation of the policy, together with the Council for Children and Adolescents—a government body specialized in children’s related affairs. Finally, the Vice-President’s Department of Social Services will supervise the children’s school attendance and, through home visits, will help guarantee the improvement of the children’s living conditions, both in their homes with their families and in a wider social context.

Information sessions are being organized by the Ministry of Health, jointly with the Vice-presidency to explain how the policy works for the children’s caregivers. Staff in health facilities is also being trained on how to implement the programme effectively. Guayaquil, one of the regions where the policy was introduced, recently hosted a meeting to provide information and training for health service coordinators and staff. “For the first time in Ecuador, health and the HIV response are linked to a social protection policy. It is a comprehensive approach for social care of children living with HIV, which includes health, nutrition, education and protection,” stresses Juan Vasconez, UNAIDS Country Coordinator for Ecuador.

Steady progress in access to HIV services

Ecuador is one of the Latin American countries which is showing steady progress in the scale up of antiretroviral treatment for people living with HIV as well as the provision of services to stop new HIV infections among children. In 2011, 67% of people living with HIV in need of HIV treatment were accessing it, compared to 39% in 2009.  Furthermore, 85% of the resources needed to provide HIV treatment originates from national sources.

L to R: UNAIDS Country Coordinator for Ecuador, Juan Vasconez, UNAIDS Regional Director for Latin America, César A. Núñez, and Vice-President of Ecuador, Lenin Moreno.

In 2001, a health service policy was introduced to ensure that pregnant women living with HIV have access to pre- and post-natal check-ups and are able to give birth in a healthcare setting. Campaigns to encourage pregnant women to take an HIV test are carried out on a regular basis and have proven successful in recent years.  In 2011, 279 064 pregnant women were tested (78% of all pregnant women). 684 of them were diagnosed as HIV positive.  Of this group, 95% of pregnant women living with HIV received HIV treatment to prevent HIV infection to their children. In 2011, a registered 30 children were born with HIV in Ecuador.

“Such high political support at the presidential level for the elimination of new HIV infections among children in Ecuador is leading the country towards achieving the UNAIDS goal of zero new HIV infections among children by 2015,” highlighted Mr Vasconez.

Panelists in the opening ceremony of the 6th Latin American and Caribbean Forum on HIV/AIDS and Sexually Transmitted Infections, including Dr Luiz Loures of UNAIDS (pictured second from right). Credit: UNAIDS

More than 4000 delegates—including government officials, health experts, community leaders, scientists, indigenous populations, youth and people living with HIV—convened from 28-31 August in Sao Paulo, Brazil, for the 6th Latin American and Caribbean Forum on HIV/AIDS and Sexually Transmitted Infections (STIs).

Hosted by the Government of Brazil in collaboration with the Horizontal Technical Cooperation Group, PAHO, UNAIDS, UNDP, UNESCO, UNICEF and civil society regional networks, the forum provided an opportunity to take stock of progress, challenges and lessons learned in HIV responses across the region. Participants engaged on a range of issues, from AIDS financing and new HIV prevention technologies to strategies for closing treatment access gaps.

Brazil widens treatment access

As delegates gathered in Sao Paulo, Brazil’s Ministry of Health announced that it will expand its national AIDS treatment programme to include at least 35 000 more people. Brazil currently provides free antiretroviral treatment to 223 000 people living with HIV—a coverage of 69%—according to government estimates.

Prior to this week’s announcement, Brazilians with a CD4 count of 350 cells per cubic millimeter were eligible for antiretroviral treatment. Under Brazil’s new policy, treatment eligibility will start at an earlier stage of HIV infection—at a CD4 count of 500. In a statement issued on 28 August, Brazil’s Minister of Health, Alexandre Padilha, explained that this decision was based on recent studies that have shown improvement in the quality of life of people living with HIV and a reduction of adverse effects in the immediate and long term.

“Brazil’s AIDS programme sets an example not only for Latin America, but for the world,” said Dr Luiz Loures, Director of the UNAIDS Political and Public Affairs branch and a participant in the opening ceremony of the forum. He noted that Brazil’s decision to provide earlier treatment for people living with HIV may trigger a “snowball effect” and influence health policies in other countries around the world.

Progress and gaps

Many other countries in Latin America have scaled up access to HIV treatment in recent years. According to the latest data from UNAIDS, an estimated 70% of people eligible for antiretroviral treatment in the region were receiving it at the end of 2011. Wide access to treatment has helped reduce the annual number of AIDS-related deaths: from 63 000 a decade ago to 57 000 in 2011.

Despite progress, key populations across the region, particularly men who have sex with men (MSM) and transgender people, continue to be disproportionately impacted by the epidemic and have limited access to HIV prevention and treatment services—a message that resonated throughout the forum in Sao Paulo.

An estimated half of all HIV infections in Latin America result from unprotected sex between men. According to national estimates, the reported HIV prevalence among transgender people in Argentina (34%) and Peru (20.8%) stands in sharp contrast to that of the general population: 0.4% and 0.23% in these two countries, respectively.

“AIDS is no longer seen as a major problem, especially in Latin America, where we have high treatment coverage,” noted Violeta Ross, Co-founder and Chair of the Bolivian Network of People with HIV and AIDS, in an article posted on the Brazilian Ministry of Health web site. “But the data are misleading because treatment is expensive. Several countries still have enormous difficulties in ensuring access for everyone," she added.

Voices of civil society

More than 4000 delegates convened at the forum in Sao Paulo from 28-31 August. Credit: UNAIDS

Advocates at the forum emphasized the importance of community mobilization in accelerating HIV responses among vulnerable populations. “Evidence-based strategies presented at the forum show that strengthening community work—including among sexual minorities—can transform national HIV responses,” said Simon Cazal, Executive Director of Somosgay, an organization that works to promote the human rights of lesbian, gay, bisexual, transgender and inter-sex (LGBTI) people. “The LGBTI movement has set priorities, giving rise to stronger activism. We have shown that with few resources, we can accomplish a lot if we are strategic and if we work alongside communities.”

Many delegates underscored the need to bridge the AIDS response with other social movements. "We have to evolve. We cannot just fight for more condoms and medicines,” said activist Enrique Chaves, Director of Advocacy for the non-profit organization AID for AIDS International. “We must acknowledge that the struggle for access to health and HIV services is also a matter of access to employment, housing and education. We have to connect our agenda with the broader agenda of development, the struggle for social justice,” he added.

www.joinred.com

Delivering an AIDS-free generation is the goal of a new (RED) campaign unveiled this summer. In partnership with America Móvil, a leading wireless provider in Latin America, the (RED) RUSH TO ZERO campaign aims to raise awareness and mobilize resources to end new HIV infections among children by 2015.

Through the campaign, launched in June 2012, funds generated by the sale of wireless products with (Telcel)^RED and (Claro)^RED branding—two America Móvil networks—will benefit programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria that prevent new HIV infections among children in Latin America and Africa. America Móvil has committed an annual contribution of up to US $2 million to the AIDS response from 2012 to 2015 through the support of all America Móvil subsidiaries and other Grupo Carso companies, as well as the Carlos Slim Foundation.

According to the latest data from UNAIDS, an estimated 40,000 children were living with HIV in Latin America in 2011. That same year, some 2,000 children in the region were newly infected with HIV.

“UNAIDS salutes the (RED) campaign and its partners for this important initiative,” said Dr César Núñez, UNAIDS Regional Director for Latin America. “(RED) RUSH TO ZERO has helped bring us one step closer to our common goal of zero new HIV infections among children.”

(RED) campaign

Since 2006, (RED) has engaged businesses and consumers in the global HIV response raising, to date, more than US $190 million in partnership with globally-recognized brands. For each product sold, (RED) partners contribute up to 50% of profits toward the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Through the new campaign in Latin America, (Telcel)^RED and (Claro)^RED products will be displayed in Claro and Telcel stores throughout Latin America. Customers will be informed about how the campaign works and how they can help bring an end to AIDS.