HIV prevalence among adults is particularly high in Mozambique. In 2014, an estimated 1.5 million people were living with HIV in the country and HIV prevalence was estimated at 10.6%, the eighth highest in the world. However, the country is firmly committed to adopting the UNAIDS Fast-Track Strategy to break and end its AIDS epidemic by 2030.

With international support, Mozambique has managed to sharply increase its coverage of antiretroviral therapy and HIV testing and counselling since 2012. Expanded treatment coverage for pregnant women living with HIV has resulted in a 73% decline from 2011 to 2014 in new HIV infections among children. New HIV infections among adults have also been reduced, by 40% from 2004 to 2014.

During a joint mission to Mozambique on 7 and 8 December, the Executive Director of UNAIDS, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the Coordinator of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) congratulated the country for accelerating its HIV response.

In their first country mission together, Michel Sidibé of UNAIDS, Mark Dybul of the Global Fund and Deborah Birx of PEPFAR held constructive meetings with high-level governmental officials, United Nations representatives, the United States Ambassador and members of civil society. Their mission was aimed at enhancing the support provided to the country for implementing its national priorities and at strengthening the joint partnership.

They all spoke of their continued and common commitment to Mozambique and to ending the AIDS epidemic by 2030. They also highlighted the importance of ensuring that people who test positive for HIV have immediate access to HIV services, including treatment.

In a meeting with President Filipe Jacinto Nyusi, Mr Sidibé praised the government for championing a people-centred approach to health and development for everyone. He also commended the government for adopting a law in 2014 that seeks to protect the rights and dignity of people living with HIV.

Mr Sidibé welcomed the recent creation of a budget line for HIV treatment in the domestic health budget. In a meeting with the Minister of Health, Nazira Karimo Vali Abdula, he stressed that a greater domestic financial commitment is still required for a sustainable response to its epidemic. The country is currently dependent on international donor support.

Mr Sidibé attended the launch of the Fast-Track cities initiative in Maputo, which aims to achieve the UNAIDS 90–90–90 treatment target in the capital. At the signing ceremony, the Mayor and Governor of Maputo City pledged to Fast-Track the AIDS response for marginalized groups and ensure that no one is left behind.

Mr Sidibé also met with Joaquim Alberto Chissano, former President of Mozambique and a Champion for an AIDS-Free Generation in Africa, and Graça Machel, Founder of the Graça Machel Trust and Chair of the Partnership for Maternal, Newborn & Child Health. 

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Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes. 

In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.

Participants

The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.

Key messages

• PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
• In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
• Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
• The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
• Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
• Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
• More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.

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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, has appointed the First Lady of Mozambique as a Patron of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.

A long-standing champion of the response to HIV, Maria Dia Luz Guebuza has advocated for zero new HIV infections among children for a number of years. In 2012, at the 32nd Summit of Heads of State and Government of the Southern Africa Development Community (SADC) she was instrumental in convening a powerful meeting of First Ladies. During the meeting the 15 First Ladies developed the ‘Maputo Declaration on the Elimination of Mother-to-Child Transmission of HIV’ which Dr Guebuza presented to heads of State who officially adopted the declaration at the Summit.

As a Patron of the Global Plan, Dr Guebuza will highlight the need to expand both HIV prevention and treatment services to women and children not only in Mozambique but across the region, which has been most affected by the AIDS epidemic.

The Global Plan is focusing particular efforts on these 22 countries to achieve two main targets for 2015: a 90% reduction in the number of children newly infected with HIV and a 50% reduction in the number of AIDS-related maternal deaths.

Mozambique is one of the Global Plan’s 22 priority countries and according to the latest progress report Mozambique has made major strides in providing HIV prevention and treatment services for women and children. The number of women receiving antiretroviral therapy to prevent transmission to their children increased from just 38% in 2009 to 86% in 2012 (under 2010 guidelines). Subsequently the number of new infections among children fell in the same time period from 26 000 to 14 000.

The Global Plan towards elimination of new HIV infections among children by 2015 and keeping their mothers alive is an initiative which was launched in 2011 by UNAIDS and the United States Presidents Emergency Plan for AIDS Relief (PEPFAR) at the UN General Assembly High Level Meeting on AIDS.

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Actress and UNAIDS Goodwill Ambassador Naomi Watts talked about her work in support of UNAIDS’ efforts towards an AIDS free generation while in Mozambique.

Mozambique is one of the settings of a new film about the life of Diana, Princess of Wales. It’s also where UNAIDS.org caught up with actress and UNAIDS Goodwill Ambassador Naomi Watts. She talked about her work in support of UNAIDS efforts towards an AIDS free generation—ensuring no new HIV infections among children by 2015 and keeping their mothers alive.

“In the United States and Europe there are virtually no new HIV infections in children and many African countries are moving steadily in that direction,” said Ms Watts. “We at UNAIDS call that ‘getting to zero’—zero babies born with HIV and zero mothers dying of AIDS-related causes. And for us, getting to zero is not a dream or a slogan but a doable reality,” she added. 

The country she is filming in has one of the highest rates of HIV in sub-Saharan Africa—11.5% of the adult population is living with the virus. But is also one of the 22 countries that is making a concerted effort to stop new HIV infections among children as part of a Global Plan championed by UNAIDS and partners.

In 2011, 98 000 pregnant women living with HIV were in need of antiretroviral medicine to prevent transmission of HIV to their children in Mozambique—the third highest number after South Africa (241 000 women) and Nigeria (229 000 women).

The nationwide programme to stop new HIV infections among children and keep their mothers alive has grown rapidly since its inception in 2002. The number of sites offering HIV services to prevent new HIV infections in children has increased across the country from 356 in 2009 to more than a thousand in 2010. As a result, the number of pregnant women receiving HIV counselling and testing also increased from 12% in 2005 to 87% in 2010—one of the highest rates in the region. And since 2009, the percentage of pregnant women living with HIV in Mozambique receiving antiretroviral treatment to prevent transmission of HIV to their children rose from 38% to 51%.

However, much more needs to be done when nearly half the pregnant women living with HIV in Mozambique do not yet receive the medicines to prevent transmission to their children.

“I wish I could spend more time here in this beautiful country of Mozambique. I would encourage all the partners in the AIDS response to redouble their efforts here and in the other 21 highly affected countries,” said Ms Watts. “Women need access to quality, life-saving HIV prevention and treatment services for themselves and their children and I know that together we can make this a reality.”

In her role as a UNAIDS Goodwill Ambassador, Ms Watts joined former President Bill Clinton and United Nations Secretary-General Ban Ki-Moon to launch the Global Plan in June 2011 at the United Nations in New York. She has visited AIDS and maternal and child health programmes from Lusaka, Zambia to Dehli, India advocating tirelessly to ensure all countries put in place the necessary efforts to achieve a generation born free of HIV. Last week in New York, Ms Watts urged the Women Leaders Forum, which included prominent CEOs and a number of African Firs Ladies, to combine their efforts to get to zero.

UNAIDS Executive Director Michel Sidibé (pictured left) with President Armando Emilio Guebuza of Mozambique.

In a meeting with Armando Emilio Guebuza, President of Mozambique, UNAIDS Executive Director Michel Sidibé commended the Government of Mozambique on progress in the national response to HIV, which has resulted in a reduction in new HIV infections and expanded access to antiretroviral treatment.

According to the latest estimates from UNAIDS, the rate of new HIV infections in Mozambique fell by more than 25% between 2001 and 2009. More than 200 000 people living with HIV in Mozambique were receiving life-saving treatment, care and support services at the end of 2010, according to government estimates.

“Commendable coordination between the Government of Mozambique, development partners and civil society has led to the scaling up of programmes for HIV prevention, treatment and care on the ground,” said the UNAIDS Executive Director.

Despite progress, Mozambique continues to have the second highest rate of new HIV infections in the world. In his meeting with the President, Mr Sidibé stressed the need for multi-faceted HIV prevention programmes based on local knowledge of the epidemic. Such programmes would require political commitment and leadership at the highest levels, he said.

In recent years, the Government of Mozambique has made improvements in the country’s primary health care system to meet the growing demand for HIV treatment, care and services. However, bottlenecks continue to hamper the AIDS response, including weak financial and supply management systems and an inadequate health workforce. Mr Sidibé called on President Guebuza and his Government to strengthen the national health care system and increase domestic resources for the HIV response.

During the meeting, the UNAIDS Executive Director briefed the President on the launch of “Give AIDS the Red Card”—a campaign that uses the universal appeal of sports for advocacy around the UNAIDS vision of Zero new HIV infections, Zero discrimination, and Zero AIDS-related deaths. Mr Sidibé presented the President with a pledge of support for the “Red card” campaign signed by the heads of delegations from 47 countries participating in the 10^th All-Africa Games in Mozambique.

Mr Sidibé informed the President of the planned appointment of up to 12 athletes as African Goodwill Ambassadors for the “Red Card” campaign across the continent.  He urged the President to secure additional support for the “Red card” campaign from other world leaders at a UN General Assembly meeting in September 2011 and at the next African Union Commission Summit in Addis Ababa.

The meeting with the President Guebuza concluded Mr Sidibé's four-day official visit to Mozambique. While in Mozambique, the UNAIDS Executive Director also met the Prime Minister, other government officials, development partners and civil society groups to exchange views on opportunities and challenges in the national AIDS response.

A central concern raised by government officials and partners during the visit was the risk of stock-outs of antiretroviral drugs. “Drug stock-outs could potentially reverse the gains in Mozambique’s HIV treatment programme,” said Mr Sidibé. “Urgent steps must be taken to manage the risk of drug stock outs,” he added.

Executive Director Michel Sidibé and Mozambique’s Minister of Youth and Sports H.E. Pedrito Fuleda Caetano with athletes from various African countries who signed the Give AIDS the Red Card initiative.
Credit: UNAIDS/A.Joe

UNAIDS Executive Director Michel Sidibé and Mozambique’s Minister of Youth and Sports H.E. Pedrito Fuleda Caetano launched the UNAIDS initiative Give AIDS the Red Card. The announcement was made on the eve of the 10^th All-Africa Games, the continent’s largest multi-sports tournament bringing together more than 5 000 athletes.

“Reducing the numbers of new HIV infections is nowhere more imperative or urgent than in Africa,” said Mr Sidibé. “The All-Africa Games are a great occasion to raise awareness about intensifying efforts to reach UNAIDS’ vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths.”

The launch took place under the patronage of Dr. Aires Aly Bonifácio, Prime Minister of Mozambique. Attending the launch were former Mozambican President Joaquim Alberto Chissano as well as many leading athletes.

The UNAIDS Give AIDS the Red Card campaign aims to raise awareness and mobilize action to strengthen the response to HIV and accelerate progress across Africa. The campaign was introduced at the 2010 FIFA World Cup in South Africa with the support of 28 team captains. Captains of six teams at the 2011 FIFA Women’s World Cup in Germany also endorsed the initiative.

At the Maputo event, heads of national delegations to the Games, including presidents of National Olympic Committees and Ministers of Sport from 47 participating countries, agreed to sign a pledge to support the Give AIDS the Red Card campaign for Zero new HIV infections, Zero discrimination, and Zero AIDS-related deaths.

By signing the pledge, each delegation is agreeing to set up a national plan of action on the Give AIDS the Red Card campaign in consultation with UNAIDS offices upon return to their respective countries.

The 2012 Africa Cup of Nations hosted by Equatorial Guinea and Gabon will be the next platform for pan-African mobilization of the initiative.

Youth participation critical to Mozambique’s AIDS response

UNAIDS Executive Director Michel Sidibé (left) and Mozambique’s Minister of Youth and Sports H.E. Pedrito Fuleda Caetano launched the UNAIDS initiative Give AIDS the Red Card.
Credit: UNAIDS/A.Joe

The importance of youth and sporting community participation in the response to AIDS was emphasized by the UNAIDS Executive Director during his meeting with Mozambique’s Minister of Youth and Sports, H.E. Pedrito Fuleda Caetano.

Mr Sidibé asked the Ministry to use the All-Africa Games to promote this initiative across all sports disciplines during the Games and beyond. Mr Sidibé emphasised that “sport events should be viewed as key platforms to link with other social movements to drive the prevention revolution including reducing vulnerability of women and girls, scaling-up HIV testing and counselling, reduction of multiple partnership and accelerating medical male circumcision.”

Sub-Saharan Africa continues to be the region most affected by HIV, with an estimated 22.5 million people living with HIV in the region representing 68% of the global total. However significant progress is being made in the region. In 22 countries, the HIV incidence rate has declined by more than 25% between 2001 and 2009.

UNAIDS Executive Director Michel Sidibé with Prime Minister of Mozambique, H.E. Aires Aly Bonifácio

UNAIDS Executive Director Michel Sidibé met with Mozambique’s Prime Minister, H.E. Aires Aly Bonifácio as part of his four-day official visit to the country. During the meeting Mr Sidibé stressed the importance of high level political leadership, ownership and commitment to long-term predictable financing as a prerequisite for sustainable national AIDS response.

Mr. Sidibé applauded the Government’s commitment and rapid follow-up action to implement the Political Declaration adopted in June at the UN General Assembly High-Level Meeting on AIDS. “The urgency demonstrated by the Government of Mozambique to align their national strategies with the outcomes of the Political Declaration should be a model to other countries” said the Executive Director. 

Mr Sidibé underscored the importance of a prevention revolution to stop new HIV infections as well as the need to integrate the AIDS response with health and social development efforts.  “Mozambique has the second highest rate of new adult HIV infections in the world. There is a need to accelerate prevention programmes,” said Mr Sidibé.

By the end of 2010, more than 200,000 people living with HIV were receiving life-saving treatment, care and support services in the country. The national programme to prevent new HIV infections in children has rapidly expanded with the opening of 909 sites in 2010 providing 67 percent coverage to pregnant women. However, Mozambique remains one of the top five countries in the world contributing to new HIV infections among children.

Expressing concern about the fact that 97 percent of Mozambique’s AIDS budget is generated from external sources, Mr Sidibé stressed the country’s need to increase domestic resources to ensure sustainable national AIDS responses in the coming years. “Mozambique needs to develop an innovative transitional plan for sustainable financing, which includes increased national budgets, private sector contribution and social health insurance,” said the Executive Director.  

The Executive Director reiterated the commitment of the United Nations together with other key partners, including the Global Fund, PEPFAR and other bilateral partners to establishing a transparent and accountable mechanism to ensure the implementation of the third National Strategic Plan (PEN III 2010-2014) and accelerate the country’s progress towards MDG 6.

President of Swaziland AIDS Support Organization (SASO) Mr. Vusi Matgerula addressing the event on behalf of the people living with HIV movement in Swaziland. Credit: UNAIDS/G.Williams

Strengthening efforts towards a stigma-free work environment for United Nations staff living with HIV and their families, UN Plus has launched a new Friends of UN Plus initiative in Swaziland. Keeping up the momentum to break down barriers and silence around HIV in southern Africa, this will be followed by the launch of a similar initiative in Mozambique on September 23.

Friends of UN Plus is a novel initiative by UN Plus, an advocacy and support group comprising staff members who are living with HIV. UN Plus membership in the southern African region has doubled in the last year but many staff members living with HIV still feel fearful of disclosing their status. Although UN Plus has a non-disclosure policy, the reluctance to disclose HIV status reflects high stigma levels in society. The Friends initiative, therefore, is meant to provide a supportive environment to those who have reservations about being openly associated with UN Plus. It aims to be a forum through which the needs of HIV-positive staff and those caring for HIV-positive friends and family can be articulated and addressed.

Dr. Jama Gulaid, UNICEF Representative and UN HIV/AIDS Theme Group chair for Swaziland addressing the launch of Friends of UN+ in Mbabane, Swaziland on 17 September 2009. Credit: UNAIDS/G.Williams

''Today was a bold and decisive step we took for us to launch this initiative.  I am so glad that staff will now have a platform to share safely and a space for outreach.  It does not hurt to help and to reach out.  We can all do something to make life better for those in our families, offices and communities living with HIV," said an HIV positive staff member of the UN in Swaziland.

The country launches are designed to highlight workplace rights and continue the ongoing dialogue on human rights, treatment needs and challenges of people living with HIV. Through training, meetings, treatment literacy sessions and related activities the initiative aims to educate staff members about UN Plus’ contribution towards reduction of stigma and discrimination, promotion of social acceptance and increase of social, legal and leadership commitment for HIV at the UN system workplace.

Group photo of participants at the launch of Friends of UN Plus in Mbabane, Swaziland on 17 September 2009. Credit: UNAIDS/G.Williams

The Swaziland launch included a panel discussion where representatives of people living with HIV answered questions from the local press on issues of equality and rights. Two members of the local media joined the panel to share their experiences of how they cover stories of people living with HIV in a meaningful way.

Friends of UN Plus will operate in tandem with UN Cares, the UN HIV in the workplace programme, the UN Wellness Program and other workplace initiatives and agency-specific programmes that exist at country levels.