When looking after people in health-care settings, health-care workers can be exposed to a broad range of infections, including HIV. Accidental exposure to HIV in health-care settings can largely be prevented by countries creating an enabling environment and providing the services that allow health-care workers to protect themselves and others from the risk of HIV infection. However, the use of criminal law can lead to miscarriages of justice.

In Uganda, the High Court of Kampala has released Rosemary Namubiru, a 64-year-old nurse living with HIV who was convicted of negligently exposing a child to HIV while at work. The decision of the High Court to release Ms Namubiru, who has been in detention since January 2014, comes after several months of advocacy and legal procedure.

A coalition of civil society organizations, legal experts and public health professionals led the efforts and, with the support of UNAIDS, engaged the government and the judiciary to advocate for a measured, evidence-informed and rights-based response to the case.

“I am relieved that dignity has prevailed and that Ms Namubiru can return to her family,” said UNAIDS Executive Director Michel Sidibé, who joined efforts to support her release. “I thank all those in Uganda and globally who have supported this outcome. Let us continue our efforts to expand evidence and human rights as critical to ending the AIDS epidemic.”

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.

Quotes

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.

GENEVA, 1 August 2014—UNAIDS welcomes the decision of Uganda’s Constitutional Court to overturn the law that called for a 14-year jail term for a first conviction, and imprisonment for life for ‘aggravated homosexuality’. Challenged by 10 petitioners including civil society, parliamentarians and academics, the law was annulled by the Court over a lack of quorum when the bill was passed.

“This is a great day for social justice,” said Michel Sidibé, Executive Director of UNAIDS. “The rule of law has prevailed.”

UNAIDS urges the protection and safety of all people seeking health services. While homosexuality remains illegal in Uganda annulling the law could have positive public health implications. Studies show that when gay men and other men who have sex with men face discrimination including abuse, incarceration and prosecution—they are less likely to seek HIV testing, prevention and treatment services.

“President Yoweri Museveni had personally indicated to me—that he wants Uganda to accelerate its AIDS response to ensure all people have access to life-saving services,” said Mr Sidibé.

UNAIDS urges all governments around the world, to protect the human rights of lesbian, gay, bi-sexual and transgender people through repealing criminal laws against adult consensual same sex sexual conduct; implementing laws to protect people from violence and discrimination; promoting campaigns that address homophobia and transphobia; and ensuring access to health services including HIV prevention, treatment, care and support services.

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.

If signed into law the controversial bill would toughen punishments against gay people in Uganda

GENEVA, 18 February 2014—UNAIDS is deeply concerned about a bill in Uganda that would further toughen punishments against gay men.

The controversial bill, which was passed by the country’s parliament in December 2013, calls for a 14-year jail term for a first conviction, and imprisonment for life for the offence of ‘aggravated homosexuality’. The signing of the bill into law would have serious human rights implications.

“Uganda was the first country in Africa to break the conspiracy of silence on AIDS—and to give voice to the most marginalized—but now I am scared that this bill will take Uganda backwards, relinquishing its leadership role in the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “I strongly urge the Ugandan authorities to reject the bill and ensure the human rights and dignity of all people in Uganda.”

The bill also has public health implications; studies show that when gay people face discrimination including abuse, incarceration and prosecution—they are less likely to seek HIV testing, prevention and treatment services.

In 2012, there were 1.5 million people living with HIV in Uganda and 140 000 new HIV infections. Globally gay men are around 13 times more likely to become infected with HIV than the general population, emphasizing the urgent need to ensure safe access to HIV prevention and treatment services for all people everywhere.

UNAIDS urges the government of Uganda, and all governments around the world, to protect the human rights of lesbian, gay, bi-sexual and transgender people through repealing criminal laws against adult consensual same sex sexual conduct; implementing laws to protect people from violence and discrimination; promoting campaigns that address homophobia and transphobia; and ensuring access to health services including HIV prevention, treatment, care and support services.

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 to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.

President encourages Ugandans to take an HIV test

GENEVA, 8 November 2013—The Joint United Nations Programme on HIV/AIDS (UNAIDS) congratulates the President of Uganda, Yoweri Museveni and the First Lady Janet Kaguta Museveni for their renewed commitment to the HIV response.

In a bid to encourage more Ugandan citizens to know their HIV status, President Museveni took an HIV test at the Kiswa Health Centre in Kampala, Uganda in front of government officials, reporters and community members.

“President Museveni and First Lady Museveni are leading by example. I am sure their bold leadership will propel Uganda back to the forefront of the world AIDS response,” said UNAIDS Executive Director Michel Sidibé who recently visited Uganda and met with the President and the First Lady.

At the event, the President urged all Ugandans to know their HIV status and to access HIV testing and counseling. He stated that anyone living with HIV would receive a package of care, treatment and support. President Museveni also called on the public to avoid risky sexual behaviour.

The new campaign aims to reach 15 million people by the end of 2014. In November, the Ugandan government reported that 577 000 people living with HIV were accessing life-saving treatment. As part of the new campaign authorities plan to provide antiretroviral treatment to an additional 240 000 people living with HIV by 2014.

Several Ugandan ministers, senior government officials, members of parliament, cultural and religious leaders, development partners, pregnant women and their partners also took part in the HIV testing event with the President.

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 to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.

UNAIDS Executive Director Michel Sidibé met with President Yoweri Kaguta Museveni of Uganda at the State House in Entebbe. Photo courtesy of State House, Uganda.

The President of Uganda Yoweri Kaguta Museveni reaffirmed his country’s commitment to end the AIDS epidemic in a meeting with UNAIDS Executive Director, Michel Sidibé and UN Secretary General’s Special Envoy for HIV/AIDS in Africa, Dr Specioza Wandira Kazibwe. The meeting, held on 17 September at the State House in Entebbe, was an opportunity to review recent progress made in Uganda’s AIDS response.

“Under the leadership of President Museveni, Uganda is uniquely positioned to reassert its role and reputation as a success story of the AIDS response in Africa,” said Mr Sidibé.

In the late 1990’s, Uganda was internationally recognized as a success story in Africa, having reduced high HIV infection rates and extended access to life-saving treatment for people living with HIV. Between 2006 and 2011, however, there were signs that its earlier success had fallen by the way-side with new HIV infections on the rise.

New HIV infections in Uganda increased from 120 000 in 2005 to 160 000 in 2011 with a slight decrease in 2012—an estimated 140 000 new HIV infections were recorded last year.

In 2012-2013, Uganda made breakthrough progress by scaling-up its national, evidence-based response to HIV. In 2012 alone 193 000 people living with HIV were newly enrolled in the national treatment programme. The Ugandan Ministry of Health is also expanding its HIV prevention strategy to reduce the number of new HIV infections in Uganda.

Demonstrating his commitment to the AIDS response, President Museveni committed to address the upcoming high-level event on Millennium Development Goal 6 and HIV treatment organized by UNAIDS on the side-lines of the United Nations General Assembly, which will be held on 23 September 2013.

As part of the official visit, Mr Sidibé and Dr Kazibwe joined the Ugandan Minister of Local Government, Hon Adolf Mwesige during a meeting with local leaders from 112 Districts in the country. They urged the district authorities to accelerate their efforts to ensure that integrated health care services are available for people living with HIV in their communities.

“Uganda’s constitution says sovereignty is with the people and elected leaders are servants of the people,” said Dr Kazibwe, “The people who elected you are crying out to you to make sure that resources are mobilized to improve delivery of services for HIV and health at the district level,” she added.  

In his two-day official visit to Uganda, Mr Sidibé also met with the Speaker of the Ugandan Parliament, Members of Parliament from the Committee on HIV/AIDS, and representatives from civil society and private sector organizations. Issues discussed included the need to ensure social equity and the respect for human rights of key population at higher risk of HIV infection; the regional production of HIV medicines; and the importance of increasing domestic resources to sustain the national AIDS response.

UNAIDS Executive Director and First Lady of Uganda met with mothers at a health centre in Nadunget, Uganda, 16 September 2013. Credit: UNAIDS

The First Lady of Uganda, Janet K Museveni, showed her commitment to stopping new HIV infections in children by bringing a national campaign to Karamoja, one of the most disadvantaged regions of her country. She launched the Elimination of Mother-to-Child- Transmission of HIV (eMTCT) Campaign in Moroto, a city in the north eastern region on 16 September.

The campaign is part of the government’s push to prevent new HIV infections among children by promoting an antiretroviral therapy (ART) regimen where all pregnant women living with HIV are provided ART for life. This is consistent with the 2013 World Health Organization guidelines which recommend that ART be initiated in certain populations including pregnant and breast-feeding women in resource limited settings. 

Speaking at the launch, the First Lady who is also the Cabinet Minister for Karamoja Affairs said “Sadly, 65 babies are born with HIV every day in Uganda. We must give appropriate, life-saving messages if we are going to reverse this trend.”

The Minister of Health of Uganda, the UNAIDS Executive Director and other high-level dignitaries attended the launch. Uganda was recognized as a leader in Africa’s HIV response and was one of the first four developing countries in the world to provide people living with HIV with access to life-saving treatment. But in recent years, the country’s HIV response has lost some momentum. According to government figures, an estimated 140 000 new HIV infections occurred in 2012, compared to 120 000 in 2005.

There are signs Uganda is revitalizing its AIDS response. New infections among children declined from 27 000 in 2009 to 15 000 in 2012—a 49% drop. The number of women accessing prevention of mother-to-child-transmission of HIV (PMTCT) services in the country also increased rapidly from 45% in 2011 to 73% 2012.

UNAIDS Executive Director Michel Sidibé applauded the First Lady for her personal commitment to bringing HIV treatment and care services to women in poor and marginalized communities.

“Uganda brought hope to millions of people. It showed the word that AIDS can be overcome and Africans can have access to treatment.  This hope was built on courage, strong leadership and partnership,” said Mr Sidibé. “Uganda needs to bring back the courage and commitment of its early days to finish the job and have a generation born free from HIV.”

The First Lady and Mr Sidibé met with two couples, who shared their experience as parents living with HIV. “Thanks to the treatment and advice I got from the health centre I gave birth to a baby born HIV free. That baby is now two years old.” said Angella Nate, who has been living with HIV for the past last six years. “I tell everyone my story because I want all mothers to see their children grow up healthy and get the same chance in life as everybody else.”

The UNAIDS Executive Director will continue with his official visit to Uganda on 17 September, meeting with civil society groups, district level government leaders and the country’s president.

Her Royal Highness Crown Princess Mette-Marit of Norway presents the Red Ribbon Award for Stopping new HIV infections in children and keeping mothers alive, women's health to the Giramatsiko Post Test Club. XIX International AIDS Conference (AIDS 2012), Washington D.C. Credit: IAS/Ryan Rayburn

Justine, a 38-year-old Ugandan woman, tested positive for HIV during an antenatal visit at the local health centre when she was pregnant with her fourth child. After disclosing her HIV status to her husband, he left home and never came back.

She did not go through the pregnancy alone though. Justine had the support from her peers at Giramatsiko Post Test Club, a grassroots organization established in 2002 in Kabwohe, Uganda.

The organization was set up by seven women living with HIV with the aim to empower and educate their peers about HIV prevention, treatment, care and support. In addition to focusing on their health and physical well-being, Giramatisko also empowers women to understand their rights to health services.

“Finding out you are HIV-positive brings physical and spiritual distress and the accompanying shame and discrimination have prevented many individuals from seeking treatment and leading a productive life,” notes Fara Twinamatsiko, a founder and chairperson of Giramatsiko.

A peer educator from Giramatsiko referred Justine to a health facility during her pregnancy where she received antiretroviral drugs to prevent HIV transmission to her child. The drugs helped ensure that Justine gave birth to a healthy, HIV-negative baby.

With a small staff and dozens of volunteers, the Giramatsiko Post Test Club currently reaches out to women in 19 centres in the Sheema district of western Uganda where they provide emotional and psychological support, HIV testing and counselling as well as referring women to health centres to access antiretroviral medicines, antenatal care and other services.

Countering stigma and discrimination

Though stories like Justine’s are not uncommon in Uganda—and in many other parts of the world—there are signs of hope as individuals and communities take action to counter HIV related stigma, discrimination and harmful social norms.

The Giramatsiko founders have confronted discrimination head-on by disclosing their own HIV status. In doing so, they have helped hundreds of other men and women in Uganda, young and old, openly discuss their experiences. They are breaking taboos and challenging the stigma associated with HIV.

“We have a very conservative attitude towards HIV in our community, but no social problem can be solved without open discussion and education,” says Tumushabe Sedrida, Coordinator at Giramatsiko.

According to the 2011 Uganda AIDS Indicator Survey, HIV prevalence in Uganda increased from 6.4% in 2004-5 to 6.7% in 2011. To-date, the HIV prevalence among women in the age group of 15-49 is 7.7% while that of men is 5.6%. Regarding pregnant women living with HIV, an estimated 53% receive services to prevent new HIV infections in their children and just 17% receive treatment for their own health. These gaps in access to HIV services emphasize the need for organizations like Giramatsiko.

Red Ribbon Award

Ten years on, Giramatsiko continues to prove that a small group of individuals can make a big difference in the lives of an entire community.

In recognition of its efforts to reduce new HIV infections in children, keep mothers alive and change community perceptions about people living with HIV, Giramatsiko received the  UNAIDS Red Ribbon Award at the XIX International AIDS Conference in July 2012. The award recognized ten organizations worldwide that have undertaken innovative and outstanding community work in the response to HIV.

Despite recent accolades, Giramatsiko’s work is far from complete. “Our aspiration is to touch many and save more lives,” notes Ms Sedrida.