GENEVA/WASHINGTON, 10 January 2014—UNAIDS and the Organization of American States (OAS) have signed a Memorandum of Understanding (MoU) in efforts to advance the response to HIV among the OAS Member States. 

Through the MoU, UNAIDS and the OAS will increase HIV outreach activities such as information and education campaigns, policy roundtables, forums, lectures and scholarships programmes aimed at reducing new HIV infections, expanding access to antiretroviral treatment and supporting people living with HIV. UNAIDS and the OAS will also foster collaboration with regional networks of HIV positive youth to strengthen HIV awareness and prevention education, enhance social protection for young people, counter gender-based violence and challenge harmful gender norms among young people.

“HIV is more than a disease. It is an issue of security, social justice and distribution of opportunities,” said Michel Sidibé, Executive Director of UNAIDS. “We must leverage this partnership to ensure that no one is left behind in the response to HIV in the Americas and that people most affected by HIV have access to essential HIV prevention and treatment services.”

Key populations including men who have sex with men, sex workers, people who use drugs and transgender people remain most affected by HIV in Latin America and the Caribbean. Although new infections have stabilised, they are still not declining.  The existence and enforcement of punitive laws as well as widespread stigma and discrimination against men who have sex with men, transgender people and sex workers continue to marginalize people most in need and block access to lifesaving HIV services.

“We have managed to break the curve of growth of infection,” said Miguel Jose Insulza, OAS Secretary General. “We now need to address structural, cross-cutting issues, including gender-based violence.”

In June 2013 the OAS General Assembly passed the Resolution on the Promotion and Protection of Human Rights of People Vulnerable to, Living with, of Affected by HIV/AIDS in the Americas. The Resolution urges Member States to continue their efforts in support to laws and public policies to protect the human rights and fundamental freedoms of people living with HIV, and to increase HIV prevention and treatment for pregnant women and mothers, including preventing mother-to-child transmission of HIV. The Resolution also promotes greater involvement of people living with HIV in decision-making and in the drafting of policies and programmes in response to the epidemic.

As world leaders gather in the United States to pledge their commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria’s (Global Fund) replenishment conference, UNAIDS is calling for a successful outcome to ensure that no-one is left behind.

The United States is hosting the important replenishment conference which will secure financing for the Global Fund’s AIDS, TB and malaria programmes from 2014 to 2016. Ahead of the meeting, United States President Barack Obama welcomed global leaders to a special event at the White House in Washington DC.

During the event the President announced that the US has met—and in some cases exceeded—the targets set for the President's Emergency Plan for AIDS Relief (PEPFAR). The targets, set in 2011, included ensuring access to antiretroviral therapy for 6 million people living with HIV. President Obama announced that the US is currently supporting 6.7 million people in gaining access to lifesaving treatment.

As the host country, President Obama also called on other world leaders to fully support global efforts to end the AIDS epidemic and stated the US will give US$ 1 to match every US$ 2 pledged to the Global Fund by other donors over the next three years (up to US$ 5 billion). 

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UNAIDS Executive Director Michel Sidibé has been awarded the Degree of Doctor of Public Health (Honoris Causa) from Tuskegee University in Alabama – one of the oldest and well known historically black colleges in the United States. The degree was awarded in recognition of Mr Sidibé’s leadership in the international AIDS response.

Mr Sidibé received the honour while attending the University’s Annual Scholarship Convocation on 13 October 2013 as the keynote speaker. In his remarks, Mr Sidibe spoke about the parallels between the American civil rights struggle for justice and equality and the AIDS response, which promotes human rights and dignity for communities affected by the epidemic. He highlighted that in the United States, African Americans account for an estimated 44% of all new HIV infections among adults and adolescents, although representing only about 13% of the US population.

In awarding Mr Sidibe the doctorate, University President Gilbert L Rochon encouraged Mr Sidibe, through his leadership of UNAIDS and his new role as Tuskegee Alma Mater, to strengthen the university’s bridge with the United Nations and African countries to explore new breakthroughs in youth leadership, research and development, and public health. 

Tuskegee University is a renowned historically black university. Established in 1881 by Booker T. Washington, Tuskegee’s campus has been designated as a National Historic Site. Tuskegee University’s National Center for Bioethics in Research and Health Care is the first bioethics center in the United States devoted to exploring research and medical treatment of the African American community and other underserved populations.

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L to R: Ambassador Eric Goosby, US Global AIDS Coordinator; President of Rwanda, Paul Kagame; US Secretary of State, John Kerry; President of Namibia, Hifikepunye Pohamba; and South African Ambassador to the United States, Ebrahim Rasool. Credit: PEPFAR

The Secretary of State John Kerry unveiled a United States (US) plan to enter into Country Health Partnerships—a new model of collaborative work—with Namibia, Rwanda and South Africa. The announcement was made by Secretary Kerry during a high-level meeting he hosted on the margins of the 68th United Nations General Assembly.

The new initiative is intended to strengthen collaboration with selected country partner governments leading to greater and mutual accountability and long-term sustainability.

“The Country Health Partnerships are about shared responsibility, shared accountability, budget transparency, and a commitment to investing strategically based on what we’ve learned from improved data collection and analysis,” said Secretary Kerry. “South Africa, Rwanda, and Namibia are all on the front lines of these efforts.”

The meeting featured the participation of the President of Namibia, the President of Rwanda, the South African Ambassador to the United States and global health leaders including UNAIDS Executive Director, Michel Sidibé.

“To convene this meeting with key African heads of state and partners during the UN General Assembly sends a strong signal of the continued leadership and support of the US Government for the global AIDS response,” said Mr Sidibé. He also highlighted the continued commitment of UNAIDS to provide the strategic information and support for investment approaches that would help to ensure the success of the new partnerships.

During the roundtable, the Secretary of State also announced that the US will host the next Global Fund Replenishment Meeting in Washington, DC in December 2013.  Secretary Kerry highlighted the strong commitment from other donors to support the successful replenishment of the Global Fund to fight AIDS, Tuberculosis and Malaria. Earlier this year, Germany, the Nordic Countries, France and the United Kingdom have already announced important contributions to the Global Fund for the 2014 – 2016 period to support countries in their response to HIV, tuberculosis and malaria.

Clinical Director Chuck Cloniger (R) seeing his patient, Tanesh Watson for medical counseling at St. James Infirmary in San Francisco, a medical and social service organization for current and former sex workers of all genders, on 14 June 2012 in California. Credit: UNAIDS/K.Hoshino

On 20 June 2013, the United States (US) Supreme Court struck down section 7631(f) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (The Leadership Act). This provision which the Court called the “policy requirement” mandates that no funds made available under the Leadership Act may “provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.”

The US Supreme Court ruled in response to a challenge filed on 23 September 2005 by 5 civil society organizations against the provision and its negative impact on their efforts to address HIV.  The organizations include: Alliance for Open Society International; the Open Society Institute; Pathfinder International; the Global Health Council; and InterAction.

The US Supreme Court held that the policy requirement violates the First Amendment of the US Constitution which protects free speech. In particular, the Court held that the “policy requirement compels as a condition of federal funding the affirmation of a belief that by its nature cannot be confined with the scope of the Government program.”  The Court noted that “the First Amendment prohibits the government from telling people what they must say.”

Commenting on the decision of the Court, Purnima Mane of Pathfinder International said, “It has been a long and uphill battle, but we are very happy that the Court has spoken out in defense of our ability to engage with sex workers so we can better put in place programs that protect them and their clients from HIV.”

Respondents had claimed, among other things, that adopting a policy explicitly opposing prostitution may diminish the effectiveness of some of their HIV programs by making it more difficult to work with sex workers—a population at higher risk of HIV infection.

In its 2012 report, the Global Commission on HIV and the Law already noted that, “The pledge puts grantees in an impossible bind. If they don’t sign, they are denied the funds they need to control and combat HIV. If they sign, recipient organisations are barred from supporting sex workers in taking control of their own lives.”

Female sex workers are 13.5 times more likely to be living with HIV than other women of reproductive age in low-income and middle-income countries. In sub-Saharan Africa, the region with the highest HIV prevalence, the pooled HIV prevalence among sex workers is 36.9%.

The involvement and empowerment of sex workers with regard to HIV prevention, treatment and care services has shown to have great impact in reducing HIV infections among both female sex workers and the overall adult population. “The end of this requirement is a significant victory for sex workers and their advocates globally. Our contributions to effective HIV responses have now been recognised,” said Ruth Morgan-Thomas of the Global Network of Sex Work Project.

Given the importance of the case for the global AIDS response, the UNAIDS Secretariat participated as an amicus curiae (friend of the court). In that role, UNAIDS provided public health evidence and human rights arguments to support greater access to funding and resources for organisations engaged in HIV prevention, treatment, care and support services with and for sex workers. UNAIDS main points to the Supreme Court included:  1) Sex workers are among the populations most affected by HIV; 2) engagement with sex workers is essential to an effective response to HIV; and 3) any effective response requires adequate funding for programmes designed to ensure HIV prevention, treatment, care and support for sex workers.

UNAIDS Executive Director, Michel Sidibé praised the groups that were courageous enough to challenge the provision. “This shows civil society at its best - advocating for global health for all.  No group, including sex workers, should be left behind in our efforts to bring the AIDS epidemic to an end.”

US funding critical to HIV response

US leadership and generosity has been instrumental in the progress made in the global AIDS response over the last decade. Since the adoption of the Leadership Act, some 45.7 billion dollars have been made available to address HIV worldwide. The President’s Emergency Plan for AIDS Relief (PEPFAR), authorized by the Leadership Act, has been the largest health initiative ever undertaken by one country to address a global health epidemic. Thanks to US funding, access to HIV treatment has been expanded in low- and middle-income countries, and millions of lives are being saved. The decision of the US Supreme Court to strike down the policy requirement will greatly contribute to expand and improve the global AIDS response even further.

The Organization of American States (OAS)—the world’s oldest regional mechanism comprising 35 independent states of the Americas—has adopted a bold new Resolution on the Promotion and Protection of Human Rights of People Vulnerable to or Living With or Affected by HIV.

Meeting at its 43^rd General Assembly, delegates approved the Resolution which puts human rights, gender equality and social justice at the heart of the region’s HIV response. The new agreement emphasizes the importance of the greater involvement and participation of the most affected populations in the response to the epidemic.

In spite of progress addressing HIV in the region—treatment coverage is high, and new HIV infections have begun to decline in parts of the Caribbean—the Resolution recognizes the still significant challenges that remain to ensure equitable access to HIV services, particularly among most at risk groups as well as women and girls.

Opening the Assembly, Secretary General of the OAS, Jose Miguel Insulza noted the frequent ‘disregard’ of the rights of minorities but highlighted the critical opportunity the OAS provides "for frank, open policy dialogue on these issues in the Hemisphere".

Deeply rooted stigma and discrimination is still all too pervasive among community and religious leaders, service providers and state agents. This impedes access to services, employment, and in some cases, leads to social exclusion for people most vulnerable to HIV, including sex workers, men who have sex with men, transgender people, drug users and indigenous populations. The Resolution calls for specific measures to promote gender equality and address the needs of women, adolescents and girls, noting the strong inter-relation between gender-based violence as both a cause and consequence of HIV.

As discussions continue globally around the sustainability of the AIDS response, the Resolution flags the ‘exorbitant’ cost of antiretroviral treatment in some countries and the challenge of securing generic alternatives. Furthermore, despite increases in domestic funding for the AIDS response, the Resolution notes that resources are still not being sufficiently invested in programmes that support and sustain education, behavior change and other HIV prevention strategies.

The Resolution looks at ways to strengthen collaboration with international bodies such as the Inter-American Commission on Women and the Inter-American Commission on Human Rights to advocate for greater protective laws and policies. These include the exchange of experiences and best practices, the organization of joint activities, and the coordination of efforts and capacities to attain the greatest possible impact.

OAS Member States called upon UNAIDS and the Pan American Health Organization (PAHO) to join efforts in the implementation of the Resolution as well as to provide countries with support to eliminate new HIV infections among children, to ensure access to affordable treatment, to end stigma and discrimination and to promote gender equality.

"This Resolution comes at an opportune time, when global discussions on development and health are shifting, but also demonstrates that new opportunities are emerging to maintain the momentum to reach UNAIDS vision of zero discrimination, zero new HIV infections, and zero AIDS-related deaths," said UNAIDS Executive Director Michel Sidibé.

Mr Sidibé met with Secretary General Insulza in Washington DC, prior to the OAS General Assembly where he remarked that "The OAS has been a leader in driving forth discussions around affordable medicines, and is breaking new ground in terms of addressing stigma and discrimination, and recognizing the intersection between gender-based violence and HIV".

A high-level task force for ICPD presenting the paper Policy Recommendations for ICPD Beyond 2014: Sexual and Reproductive Health and Rights for All. 25 April 2013, New York. Credit: Elsa M. Ruiz

In 1994 at the International Conference on Population Development (ICPD) in Cairo, 179 countries adopted a landmark 20-year Programme of Action, placing gender equality and women’s empowerment and reproductive rights at the center of population and sustainable development.

Last week, in a review of progress which took place in New York, a high-level task force strongly urged governments and the international community to take much bolder action in order to meet the commitments.

In a paper Policy Recommendations for ICPD Beyond 2014: Sexual and Reproductive Health and Rights for All,  the task force outline specific steps to ensure that the commitments made become central components not only of next year’s conference, but also the post-2015 and sustainable development goals agenda. The task force is also calling for increased accountability mechanisms to ensure concerted action by governments to achieve these goals.

Co-chaired by former Presidents Joaquim Chissano of Mozambique and Tarja Halonen of Finland, the task force is comprised of 26 eminent government, civil society, and private sector leaders. Its mission is to galvanize political will and advance a forward-looking agenda for the ICPD Programme of Action that fulfills sexual and reproductive health and rights of all people.

“While we are encouraged by the achievements of ICPD implementation, the challenge is that too many people around the world are still denied their sexual and reproductive health and rights,” said Former President Halonen. “These are fundamental freedoms and human rights that lie at the very core of human dignity.”

The global panel of experts highlighted four main recommendations for government action:

• Respecting, protecting and fulfilling sexual and reproductive rights for all through public education and legal and policy reforms
• Achieving universal access to quality, comprehensive and integrated sexual and reproductive health information, education and services
• Ensuring universal access to comprehensive sexuality education for all young people
• Eliminating violence against women and girls and securing universal access to critical services for all victims/survivors of gender-based violence

Within those four areas are recommendations for specific actions on a range of issues including; ending unsafe abortion, ending acts of violence against women and girls; and ensuring equality under the law regardless of sexual orientation or gender identity, HIV or other status.

UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle participating at the launch of the policy recommendations. Credit: Elsa M. Ruiz

All four key recommendations are highly relevant for UNAIDS and the global AIDS response. The HIV epidemic continues to disproportionately affect young women and girls, with infection rates twice as high as young men. Every minute a young woman is newly infected with HIV. Globally, AIDS is the leading cause of death in women of reproductive age.

UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle, stressed that sexual and reproductive health and rights for women and girls, gender equality and the elimination of violence against women are central to the work of UNAIDS in achieving the targets of the 2011 United Nations General Assembly Political Declaration on HIV/AIDS.

“To achieve our objective of inclusive development rooted in equality and social justice, we need to leverage synergies across movements, bringing together the capacity and innovation of the AIDS response with movements to advance sexual and reproductive health and rights, gender equality and the empowerment of women and young people,” said Ms Beagle.

The panelists at the launch were: Luis Ubiñas, President of the Ford Foundation; H.E. Tarja Halonen Former President of Finland, and Co-Chair of the High-Level Task Force for the ICPD; H.E. Joaquim Chissano Former President of Mozambique, and Co-Chair of the High-Level Task Force for the ICPD; Dr. Babatunde Osotimehin, Executive Director, United Nations Population Fund; Ishita Chaudhry, CEO & Founder of The YP Foundation, and Member of the High-Level Task Force for the ICPD; Her Royal Highness Crown Princess Mary of Denmark, and Member of the High-Level Task Force for the ICPD; H.E. Joy Phumaphi, Former Minister of Health of Botswana & Member of the Global Leaders Council for Reproductive Health.