Mali

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

UNAIDS extends its heartfelt thanks to the Executive Director of UNAIDS for his outstanding contribution to the global response to HIV

GENEVA, 8 May 2019—UNAIDS congratulates Michel Sidibé on his appointment as the Minister of Health and Social Affairs of Mali. Mr Sidibé served as the Executive Director of UNAIDS for more than 10 years after being appointed as the second Executive Director of UNAIDS and Under-Secretary-General of the United Nations in January 2009.

A true champion for a people-centred approach to health and development and a strong advocate for social justice, Mr Sidibé has made a remarkable contribution to the AIDS response, helping to save and improve the lives of millions of people around the world.

Since Mr Sidibé took up his position as Executive Director of UNAIDS, there has been a 170% increase in the number of people accessing antiretroviral therapy, from 8 million in 2010 to 21.7 million in 2017. There has also been a 45% drop in AIDS-related deaths—from 1.7 million in 2008 to 940 000 in 2017—and new HIV infections have been reduced by 22%—from 2.3 million in 2008 to 1.8 million in 2017.

“It has been an honour for me to serve UNAIDS as its Executive Director and contribute to the global AIDS response,” said Mr Sidibé. “I would like to thank all UNAIDS partners and staff and especially community members affected by HIV, who have made our successes possible. With their steadfast commitment and resolve, we have been able to bring life-saving services to millions of people. If we stay the course and do the right thing, always—putting people first and delivering results for people—we will succeed in ending AIDS.”   

Mr Sidibé’s vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, and his tireless advocacy to ensure that all people have access to health services, have kept HIV at the top of the global agenda. His calls for global solidarity and shared responsibility have seen resources for HIV increase by more than one third, from US$ 15.9 billion in 2010 to US$ 20.6 billion in 2017 in low- and middle-income countries. His advocacy for country ownership helped to ensure that 56% of HIV resources in low- and middle-income countries now come from domestic sources, promoting long-term sustainable responses to HIV.  

His commitment to the concept of universal access to HIV prevention, treatment, care and support meant that the goal of reaching 15 million people living with HIV with antiretroviral therapy by 2015 was achieved seven months ahead of schedule. His focus on the most vulnerable and marginalized has given a voice to the voiceless, including gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs, prisoners and other incarcerated people, and people on the move.

A strong believer that no child should be born with HIV, his leadership in calling for the elimination of new HIV infections among children contributed to a 60% reduction in new paediatric HIV infections since 2009 in the 21 priority countries of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.

During his tenure, Mr Sidibé spearheaded two of the most successful United Nations General Assembly political declarations on HIV, which named key populations and included ambitious regional and global Fast-Track Targets. He has successfully advocated to take AIDS out of isolation, encouraging a holistic human-rights based approach to include HIV as part of sexual and reproductive health and integrate responses to interlinked diseases, including tuberculosis and cervical cancer.

“I would like to thank United Nations Secretary-General António Guterres for his long-standing support to UNAIDS,” said Mr Sidibé. “I am also grateful to the United Nations system for allowing me to develop my career, from when I started as a short-term junior professional in the Democratic Republic of the Congo for the United Nations Children’s Fund in 1987 to becoming Under-Secretary-General of the United Nations some 20 years later—I am eternally thankful for the opportunities I have been given.”

The countries most affected by HIV have rallied behind Mr Sidibé’s call to reach the 90–90–90 targets, whereby 90% of people living with HIV know their status, 90% of people who know their status are accessing treatment and 90% of people on treatment have a suppressed viral load. Some 75% of all people living with HIV now know their HIV status, and focus has been increased on HIV testing and expanding antiretroviral therapy.

His call with partners to establish an HIV prevention coalition led to a new HIV Prevention 2020 Road Map to strengthen and sustain political commitment for primary HIV prevention and establish accountability for delivering services at scale in order to stop new HIV infections.

His commitment to improving the lives of women and girls galvanized action for Security Council resolution 1983 in 2011, which focused on ensuring access to HIV prevention and treatment for women and girls, on the prevention of, and response to, sexual violence related to conflict and on post-conflict peacebuilding.

Mr Sidibé’s strong belief in the power of communities has paved the way for community-led responses to HIV, which have proved to be a gamechanger in increasing the uptake of HIV services and in creating support networks to improve adherence to treatment and quality of life for people living with HIV.  

His undeterred commitment, dedication and passion has allowed Mr Sidibé to engage heads of state, people living with HIV, affected communities, donors, first ladies, parliamentarians, Mayors, civil society, scientists, young people and HIV programme leaders alike, bringing everyone around the same table to galvanize action to end AIDS by developing focused and sustainable solutions that leave no one behind.

Mr Sidibé has been an inspirational leader of UNAIDS and for the global response to HIV, and UNAIDS extends its heartfelt thanks for his years of dedicated service. Mr Sidibé will take on his new role as Minister of Health and Social Affairs of Mali with immediate effect and will be replaced ad interim by UNAIDS Deputy Executive Director, Management and Governance, Gunilla Carlsson.

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.

The Executive Director of UNAIDS has been nominated by the new United Nations Secretary-General, António Guterres, to represent him at the 2017 Africa–France Summit in Bamako, Mali. The summit, co-organized by France and Mali and taking place on 13 and 14 January, will welcome around 2000 participants across the two days. Around 30 heads of state and government are expected to attend, including the President of France, François Hollande, and the President of Mali, Ibrahim Boubacar Keïta.

The theme of the summit is partnerships, peace and security, and in addition to strengthening cooperation between Africa and France, discussions will take place on the current and emerging threats to peace and security and ways of countering them, including improving education and training, increasing investment and bolstering development efforts.

The heads of state will meet in closed sessions devoted to two overarching themes: security, including the fight against terrorism, the economy and development.

On the eve of the event, Mr Sidibé gave the keynote speech at the Youth Forum, which is supported by the United Nations Population Fund, where he called for the empowerment of young people and for social safety nets to be put in place to ensure a more secure future for African youth. The young people prepared a statement in which they called for more investment in young people to enable them to reach their full potential.

As well as participating in the official Africa–France Summit programme and holding one-on-one meetings with high-level representatives, Mr Sidibé will attend an event for first ladies, hosted by the First Lady of Mali, Keita Aminata Maiga, which is aimed at moving the reproductive health agenda forward for young people across Africa. At the end of the session, the first ladies are expected to adopt a commitment to action on health and young people. 

The Ebola virus is continuing to claim lives across West Africa. Guinea, Liberia and Sierra Leone are the worst-affected countries, with transmission still widespread. Some 15 300 cases have been reported since the start of the outbreak and more than 5450 people have died. Mali, previously free from the virus, is the latest country to register Ebola cases, six in total, all of which have been fatal.

The Executive Director of UNAIDS, Michel Sidibé was accompanied by the Director-General of the World Health Organization, Margaret Chan, on a recent visit to Mali to support the country in its efforts to curb the spread of Ebola and translate lessons learned from the AIDS epidemic into action on the ground.

Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Jean-François Delfraissy, French coordinator of the international and national Ebola response, joined the high-level visit.

Together with the Malian Minister of Health, the delegation visited an Ebola treatment centre in Bamako run by Médecins Sans Frontières, where an Ebola patient is being treated. They later met with civil society representatives, religious leaders and health workers.

The next 15 days are critical for ending Ebola in Mali. The coordination of action and strategic communication are key to success, as are immediate international funding and technical assistance.

While in Mali, Mr Sidibé met with President Ibrahim Boubacar Keïta and Prime Minister Moussa Mara and joined First Lady Keïta Aminata Maïga to visit a health centre that works to prevent mother-to-child transmission of HIV.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

The Executive Director of UNAIDS Michel Sidibé was in the Malian capital Bamako over the weekend. He was there to take part in a ceremony marking the reinstatement of funding by the Global Fund to Fight AIDS, Tuberculosis and Malaria for a full-scale HIV programme in Mali.

Under the new agreement, the Global Fund has approved funding for US$ 75 million for HIV screening, prevention and treatment in Mali over the next three years. Efforts will be increased to expand HIV prevention services, particularly to reach key populations at higher risk. A high priority will be to stop new HIV infections in children and widen voluntary testing efforts. Improvements will also be made in coordination and in monitoring and evaluation of the response to HIV in Mali.

The Global Fund announced that it would be resuming its funding in November last year after having reduced funding in 2011 when mismanagement of funds was discovered. Since then both the Government of Mali and the Global Fund have taken essential measures to restore confidence in grant management and ensure continuity of HIV services for people most in need.

Some 110 000 people are estimated to be living with HIV in Mali and 30 000 are receiving antiretroviral therapy.

UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit of Norway addressing young people at the Mali Youth Summit. 16 April 2011. Credit: UNAIDS\AFP H. KOUYATE

UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit of Norway travelled to Bamako, Mali to participate in the Youth Summit on HIV, an event convened under the patronage of the President of the Republic of Mali, Amadou Toumani Touré, and co-hosted by UNAIDS.

HRH Crown Princess Mette-Marit of Norway addressed an audience of more than 150 young leaders at the youth summit. Speaking at a session on transformative social movements, the Crown Princess highlighted the opportunities offered by the social media tools to empower young people in new areas of advocacy.

“Young people must be mobilized to respond to deeply entrenched stigma and discrimination and a growing conservative backlash which threatens their access to sexual and reproductive health services, sexuality education, sexual expression, harm reduction and safety as human rights defenders,” said HRH Crown Princess Mette-Marit.

She encouraged young people to learn from different social movements to engage others in the AIDS response. The Crown Princess emphasized that it is the young who are sitting with the solutions and must have the opportunity to be heard. 

“My message to you is: When you experience lack of core funding, lack of data on young people, lack of personal rights or lack of access to treatment, use your courage, use your ideas and start your own social movements,” said the Crown Princess. “Use your networks to create a momentum so that our leaders can't afford not to listen. Make them so powerful that world leaders cannot neglect them.”

Joint visit to a neighbourhood clinic

Together with UNAIDS Executive Director Michel Sidibe UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit visited a small clinic in one of Bamako's neighbourhoods that provides sexual and reproductive health as well as HIV services free of charge.

In less than 70 square meters, community members have access to information about HIV, training in the use of contraceptives and free HIV testing. The clinic also provides support for people living with HIV as well as HIV treatment.