Young people
Feature Story
Global scientific leaders explore strategies to achieve the 90-90-90 target
22 July 2015
22 July 2015 22 July 2015Leading HIV researchers describing results from multiple clinical trials in sub-Saharan Africa report that innovative service delivery models are achieving results across the HIV treatment cascade that approach or exceed the 90–90–90 target.
Study results were presented at an all-day workshop hosted by the British Columbia Centre for Excellence in HIV/AIDS and the Division of AIDS at the University of British Columbia, prior to the opening of the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada. The studies are being undertaken in a number of high-burden countries in sub-Saharan Africa, including Botswana, Kenya, Malawi, South Africa, Swaziland, Uganda and Zambia.
“These exceptional clinical trial results show yet again how innovation is driving progress in the AIDS response,” said UNAIDS Executive Director Michel Sidibé. “The results demonstrate that the 90–90–90 target is more than a dream. It is entirely feasible.”
Diane Havlir, of the University of California, San Francisco, presented interim results from the Sustainable East Africa Research for Community Health (SEARCH) trial in more than 30 rural communities in Kenya and Uganda. Having enrolled more than 334 000 people, the SEARCH trial is evaluating a multicomponent programme, including use of community-centred, multidisease campaigns to provide HIV testing and link HIV-positive individuals to immediate initiation of antiretroviral therapy.
At a population level, the SEARCH programme has achieved 90% knowledge of HIV status. Among participants living with HIV, more than 90% of people in Uganda and 83% in Kenya are receiving antiretroviral therapy. At 24 weeks, 92% of trial participants who have initiated antiretroviral therapy have achieved viral suppression.
Similarly encouraging, although preliminary, results were reported from the PopART trial by Richard Hayes of the London School of Hygiene and Tropical Medicine. Working in 21 communities, the trial is evaluating a combination HIV prevention package that includes repeated rounds of community-level HIV testing and immediate initiation of antiretroviral therapy for all people who are diagnosed HIV-positive. Among more than 115 000 community members enumerated in the trial, 90% of all men living with HIV and 92% of all women living with HIV were aware of their HIV status following the PopART programme. Among people with an HIV diagnosis, 62% of men and 65% of women were receiving antiretroviral therapy, highlighting the need to further strengthen linkage to care for people living with HIV. Data on rates of viral suppression among PopART participations will be available next year.
Max Essex, of the Harvard University School of Public Health, presented baseline findings for the Botswana Combination Prevention Protocol. Mr Essex and his colleagues have found that 79% of all people living with HIV in Botswana knew their HIV status as of mid-2015, 86% of adults who have been diagnosed with HIV were receiving antiretroviral therapy and 96% of people receiving antiretroviral therapy had achieved viral suppression.
Comparably impressive results have been achieved by a Médicins Sans Frontières (MSF) programme in the District of Chiradzulu in Malawi, according to David Maman of MSF. In Chiradzulu, 77% of all people living with HIV know their HIV status, 84% of people with an HIV diagnosis are receiving antiretroviral therapy and 91% of people receiving antiretroviral therapy have achieved viral suppression.
François Dabis, of the Bordeaux School of Public Health, described preliminary results from a separate trial in the Hlabisa district in KwaZulu-Natal, South Africa, of a test-and-treat initiative that includes six-month rounds of community-level testing and establishment of antiretroviral treatment sites in all communities in the study. Among more than 26 000 people in the study communities, 85% know their HIV status. Among HIV-diagnosed people reached by the programme, 86% are receiving antiretroviral therapy. Study results indicate that linkage to care remains suboptimal and an important focus of further work and innovation.
Several important themes emerged from these study findings. Researchers emphasized the importance and value of engaging and collaborating with local communities in developing programme approaches tailored to local needs and circumstances. Most of the studies have also taken multidisciplinary approaches to the development, monitoring and evaluation of programmes, involving social scientists, economists and community representatives as well as clinicians and biostatisticians.
Related
U=U can help end HIV stigma and discrimination. Here’s how
27 February 2025
Feature Story
Vancouver delegates call for greater innovation in HIV diagnostics
22 July 2015
22 July 2015 22 July 2015Innovation in HIV diagnostics is urgently needed if the world hopes to achieve the 90–90–90 target for access to antiretroviral therapy, leading scientific experts advised this week. The call for intensified effort and innovation on HIV diagnostics occurred during two sessions at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, held in Vancouver, Canada.
“It is clear that we can’t accept business as usual when it comes to HIV diagnostics,” said UNAIDS Deputy Executive Director Luiz Loures, who moderated a special satellite session on enhancing diagnostic access. “We must do things differently if we are to reach the 90–90–90 target.”
Global experts focused on three key diagnostic challenges: ensuring timely diagnosis of HIV among children, rapidly increasing knowledge of HIV status among adults living with HIV and scaling up essential viral load testing. These three focus areas are key priorities for the Diagnostics Access Initiative, a multi-stakeholder global initiative that aims to fully leverage the potential of laboratory medicine to lay the groundwork to end the AIDS epidemic as a public health threat.
Diagnosing children living with HIV
Unlike adults, who can be diagnosed with HIV through a simple antibody test, very young children require more expensive molecular tests, which use centralized laboratories that are remote from clinical sites. This creates substantial delays in diagnosing HIV-exposed children and also increases both costs and the risks that specimens or results will be lost. Even when early infant diagnostic services are available, many HIV-exposed children only receive their HIV test results after the time when peak mortality occurs, at six to eight weeks old, according to Trevor Peter, of the Clinton Health Access Initiative (CHAI).
Relatively simple, point-of-care diagnostic tests for early infant diagnosis are now emerging, Mr Peter reported, and these will need to be rapidly scaled up. In addition, mobile health technologies have the potential to reduce delays in the communication of test results and help ensure that test results for HIV-exposed children are actually received at the clinical site. At the Vancouver conference, UNAIDS and its partners in the Diagnostics Access Initiative announced with Roche Diagnostics a 35% decline in the global price for early infant diagnostic testing.
Ensuring 90% knowledge of HIV status among adolescents and adults living with HIV
UNAIDS sponsored a separate session at the conference on democratizing HIV testing to reach the 90–90–90 target. Joseph Amon of Human Rights Watch advised that all people should feel empowered to choose where, when and how they want to be tested for HIV. Consistent with this human rights approach, there is growing interest in HIV self-testing tools.
New international guidelines on HIV testing services, launched by the World Health Organization (WHO) in Vancouver this week, indicate that WHO envisages widespread access to self-testing as an important component of a comprehensive HIV testing effort. Several countries in different regions currently allow HIV self-testing, but most countries have yet to adapt their laws and regulatory frameworks to permit it.
The new WHO guidelines on HIV self-testing emphasize the importance of moving testing access closer to communities. In particular, the new guidelines recommend steps to enable lay workers to administer HIV tests. Results from the Sustainable East Africa Research for Community Health (SEARCH) trial in more than 30 rural communities in Kenya and Uganda indicate that population-level knowledge of HIV status approaching or exceeding 90% can be achieved through community-owned, multidisease testing campaigns.
Presenting modelling work, John Stover of Avenir Health said that 90% knowledge of HIV status is achievable more broadly through a strategic combination of testing strategies, such as provider-initiated testing in diverse health settings, outreach to key populations, fixed centres for HIV testing and counselling, and various community-based approaches, such as HIV self-testing, mobile testing and door-to-door, home-based efforts.
Ensuring universal access to viral load testing
Conference participants also heard urgent calls to expand access to viral load testing. Not only is access to viral load testing essential for monitoring the 90-90-90 target, but viral load testing is an essential clinical tool to detect early treatment failure and permit intervention to improve treatment adherence. However, projections by CHAI indicate that current trends in the uptake of viral load testing are insufficient to ensure achievement of the 90–90–90 target.
During the diagnostics-focused sessions, several ways forward were suggested to close the viral load testing gap. Partners in the Diagnostics Access Initiative, along with the Government of South Africa, last year concluded an agreement with Roche Diagnostics to reduce the price of viral load testing by 40% worldwide. In addition, steps need to be taken to maximize the effective use of the viral load platforms that presently exist, as many viral load technologies are severely under-utilized at present.
Update
Promoting HIV testing among young people in South Africa
20 July 2015
20 July 2015 20 July 2015On Nelson Mandela International Day, 18 July, UNAIDS brought together a small group of artists for a joint visit to South Africa to raise awareness about HIV among young people.
The grandsons of Nelson Mandela, Ndaba and Kweku Mandela, joined the group, which included North American actress and singer Zendaya and Norwegian musical duo Nico & Vinz.
The group met with young people living with HIV to learn about the challenges they face on a daily basis to access HIV and other health-related services. They also visited several HIV programmes and witnessed how a community-led health programme is providing HIV services in Mthatha, Eastern Cape, near the birthplace of former President Mandela.
HIV is the number one contributor to adolescent mortality in Africa. Discrimination, poverty, inequalities and harsh laws often prevent adolescents from seeking and receiving HIV testing, health care and support. Too many adolescents do not get tested for HIV or receive counselling, especially adolescents at a higher risk of HIV infection and the most marginalized adolescents—adolescent girls, adolescent males who have sex with males, adolescents who inject drugs and sexually exploited adolescents.
The visit gave the group an insight of the importance of removing barriers to access HIV testing and the participants had the opportunity to engage with the ProTESTHIV initiative, which promotes HIV testing.
Quotes
“Like my grandfather used to say, “It always seems impossible until it’s done.” We are the generation that will end the AIDS epidemic.”
“On this trip, I have seen first-hand the power that the youth have to take charge of their lives, get tested and make the right choices.”
“Getting tested for HIV is the first step to a healthier life, whether it’s a positive or negative result.”
“Someone said to us “It’s all about loving yourself.” I hope to use my voice to get that message out.”
“I always say that the younger generations are not the leaders of the future. They are the leaders of today. They will be the ones to end the AIDS epidemic.”
Region/country
Related
Comprehensive update on HIV programmes in South Africa
25 February 2025
Documents
Oral pre-exposure prophylaxis–putting a new choice in context
12 July 2015
The World Health Organization (WHO) anticipates releasing updated guidance on oral pre-exposure prophylaxis (PrEP), containing tenofovir (TDF), as an additional HIV prevention choice. The new guidance is likely to be significantly broader than previously and creates real opportunities to move forward with implementing PrEP as part of comprehensive HIV programmes. This publication, produced collaboratively between UNAIDS, WHO and AVAC, is intended to complement WHO recommendations and support the optimal use of oral PrEP to protect individuals and contribute to ending the AIDS epidemic.
Related
U=U can help end HIV stigma and discrimination. Here’s how
27 February 2025
Impact of community-led and community-based HIV service delivery beyond HIV: case studies from eastern and southern Africa
30 January 2025
Lost and link: Indonesian initiative to find people living with HIV who stopped their treatment
21 January 2025
Feature Story
UNFPA, WHO and UNAIDS: Position statement on condoms and the prevention of HIV, other sexually transmitted infections and unintended pregnancy
07 July 2015
07 July 2015 07 July 2015Condoms are a critical component in a comprehensive and sustainable approach to the prevention of HIV and other sexually transmitted infections (STIs) and are effective for preventing unintended pregnancies. In 2013, an estimated 2.1 million people became newly infected with HIV[i] and an estimated 500 million people acquired chlamydia, gonorrhoea, syphilis or trichomoniasis.[ii] In addition, every year more than 200 million women have unmet needs for contraception,[iii] leading to approximately 80 million unintended pregnancies.[iv] These three public health priorities require a decisive response using all available tools, with condoms playing a central role.
Male and female condoms are the only devices that both reduce the transmission of HIV and other sexually transmitted infections (STIs) and prevent unintended pregnancy.
Laboratory studies show that condoms provide an impermeable barrier to particles the size of sperm and STI pathogens, including HIV.[v] [vi] Condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV. Research among serodiscordant couples (where one partner is living with HIV and the other is not) shows that consistent condom use significantly reduces the risk of HIV transmission both from men to women and women to men[vii] [viii] [ix] Consistent and correct use of condoms also reduces the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer.[x] With a failure rate of about 2% when used consistently and correctly, condoms are very effective at preventing unintended pregnancy.[xi] [xii]
Condoms have played a decisive role in HIV, STI and pregnancy prevention efforts in many countries.
Condoms have helped to reduce HIV transmission and curtailed the broader spread of HIV in settings where the epidemic is concentrated in specific populations.[xiii] Distribution of condoms has been shown to reduce rates of HIV and other STIs in sex workers[xiv] [xv] [xvi] and men who have sex with men.[xvii] In India[xviii] [xix] and Thailand[xx] increased condom distribution to sex workers and their clients in combination with other prevention interventions were associated with reductions of transmission of both HIV and other STIs. Zimbabwe[xxi] and South Africa are two high-prevalence countries where increased condom use was found to contribute to reductions in HIV incidence.[xxii]
A recent global modelling analysis estimated that condoms have averted around 50 million new HIV infections since the onset of the HIV epidemic.[xxiii] For 2015, 27 billion condoms expected to be available globally through the private and public sector will provide up to an estimated 225 million couple years protection from unintended pregnancies.[xxiv] [xxv]
Condoms remain a key component of high-impact HIV prevention programmes.
Recent years have seen major scientific advances in other areas of HIV prevention. Biomedical interventions including antiretroviral therapy (ART) for people living with HIV can substantially reduce HIV transmission. While the success of ART may alter the perception of risk associated with HIV, studies have shown that people living with HIV who are enrolled in treatment programmes and have access to condoms report higher condom use compared to those not enrolled.[xxvi]
Condom use by people on HIV treatment and among serodiscordant couples is strongly recommended. [xxvii] Only when sustained viral suppression is confirmed and very closely monitored, and when the risk of other STIs and unintended pregnancy is low, it may be safe not to use condoms.[xxviii] [xxix] [xxx]
Oral pre-exposure prophylaxis (PrEP)—where antiretroviral drugs are used by HIV-negative people to reduce their risk of acquiring HIV—is also effective in preventing HIV acquisition, but is not yet widely available and is currently only recommended as an additional tool for people at higher risk, such as people in sero-discordant relationships, men who have sex with men and female sex workers, in particular in circumstances in which consistent condom use is difficult to achieve.[xxxi] Voluntary medical male circumcision (VMMC) can reduce the risk of HIV acquisition by 60% among men, but because protection is only partial, should be supplemented with condom use. [xxxii]
Hence, condom use remains complementary to all other HIV prevention methods, including ART and PrEP, in particular when other STIs and unintended pregnancy are of concern. The roll-out of large-scale HIV testing and treatment, VMMC and STI control programmes, and efforts to increase access to affordable contraception all offer opportunities for integrating condom promotion and distribution.
Quality-assured condoms must be readily available universally, either free or at low cost.
To ensure safety, efficacy and effective use, condoms must be manufactured according to the international standards, specifications and quality assurance procedures established by WHO, UNFPA and the International Organization for Standardization[xxxiii] [xxxiv] and made available either free or at affordable cost. Condom use in resource-limited settings is more likely when people can access them at no cost or at subsidized prices.[xxxv] [xxxvi]
Most countries with high HIV rates continue to heavily depend on donor support for condoms. In 2013, only about 10 condoms were made available to every man aged 15-64, and on average only one female condom per eight women in sub- Saharan Africa. HIV prevention programmes need to ensure that a sufficient number and variety of quality assured condoms are accessible to people who need them, when they need them. Adequate supplies of water based-lubricants also need to be provided to minimize condom usage failure, especially for anal sex, vaginal dryness and in the context of sex work.[xxxvii]
Despite generally increasing trends in condom use over the past two decades, substantial variations and gaps remain. Reported condom use at last sex with non-regular partners ranges from 80% use by men in Namibia and Cambodia to less than 40% usage by men and women in other countries, including some highly affected by HIV. Similarly, among young people aged 15 to 24 years, condom use at last sex varies from more than 80% in some Latin American and European countries to less than 30% in some West African countries.[xxxviii] This degree of variation highlights the need for countries to set ambitious national and subnational targets and that in many settings there are important opportunities for strengthening demand and supply of condoms.
Programmes promoting condoms must address stigma and gender-based and socio-cultural factors that hinder effective access and use of condoms.
Effective condom promotion should be tailored for people at increased risk of HIV and other STIs and/or unintended pregnancy, including young people, sex workers and their clients, injecting drug users and men who have sex with men. Many young women and girls, especially those in long-term relationships and sex workers, do not have the power and agency to negotiate the use of condoms, as men are often resistant to using condoms. Within relationships, the use of condoms may be taken to signal a lack of trust or intimacy.
However, few programmes adequately address the barriers that hinder access and use of condoms by young people,[xxxix] key populations[xl] and men and women in relationships. In some contexts, sex workers are forced to have unprotected sex by their clients.[xli] [xlii] and carrying condoms is criminalized and used as evidence by police to harass or to prove involvement in sex work[xliii] [xliv] These practices undermine HIV prevention efforts and governments should take actions to end these human rights violations.[xlv] Condom programmes should ensure that condoms and lubricants are widely available and that young people and key populations have the knowledge, skills and empowerment to use them correctly and consistently.[xlvi] Condoms should also be made available in prisons and closed settings,[xlvii] [xlviii] and in humanitarian crises situations.[xlix]
Adequate investment in and further scale up of condom promotion is required to sustain responses to HIV, other STIs, and unintended pregnancy.
Despite the low cost of condoms, international funding for condom procurement in sub-Saharan Africa has stagnated in recent years.[l] Collective actions at all levels are needed to support the efforts of countries that depend on external assistance for condom procurement, promotion, and distribution and to increase domestic funding and private sector investment in condom distribution and promotion.[li]
Although condoms are part of most national HIV, STI and reproductive health programmes, condoms have not been consistently distributed nor promoted proactively enough.[lii] National condom distribution and sales can be strengthened by applying a total market approach that combines public sector distribution, social marketing and private sector sales.[liii] [liv] Administrative barriers that prevent programmes and organizations from providing sufficient quantities of condoms for distribution need to be removed. In high-HIV prevalence locations condom promotion and distribution should become systematically integrated in community outreach and service delivery, and in broader health service provision.
[i] UNAIDS. 2014. World AIDS Day Report 2014.
[ii] WHO, Dept. of Reproductive Health and Research. Global incidence and prevalence of selected curable sexually transmitted infections.
[iii] UNFPA/Guttmacher Institute. 2012. Adding It Up: Costs and Benefits of Contraceptive Services.
[iv] Sedgh G et al. Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends. Studies in Family Planning, 2014, Vol 45. 3, 301–314, 2014.
[v] Carey RF et al. Effectiveness of latex condoms as a barrier to human immunodeficiency virus-sized particles under conditions of simulated use. Sex Transm Dis 1992;19:230-4.
[vi] WHO/UNAIDS. 2001. Information note on Effectiveness of Condoms in Preventing Sexually Transmitted Infections including HIV.
[vii] Holmes K et al. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization, 2004, 82 (6).
[viii] Weller S et al. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1):CD003255.
[ix] Smith DK et al. Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2015 Mar 1;68(3):337-44.
[x] Also see: http://www.cdc.gov/condomeffectiveness/brief.html
[xi] Trussell J. Contraceptive efficacy, in: Hatcher RA et al., eds., Contraceptive Technology: Twentieth Revised Edition, New York: Ardent Media, 2011, pp. 779–863.
[xii] Kost K et al. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception, 2008; 77:10-21.
[xiii] Hanenberg RS et al. Impact of Thailand's HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet, 1994, 23;344(8917): 243-5.
[xiv] Ghys PD et al. Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Cote d’Ivoire, 1991–1998. AIDS, 2002, 16(2):251–258.
[xv] Levine WC et al. Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project. AIDS, 1998, 12(14):1899–1906.
[xvi] Fontanet AL et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial. AIDS, 1998, 12(14):1851–1859.
[xvii] Smith D et al. Condom efficacy by consistency of use among MSM: US. 20th Conference on Retroviruses and Opportunistic Infections, Atlanta, abstract 32, 2013.
[xviii] Boily M-C et al. Positive impact of a large-scale HIV prevention programme among female sex workers and clients in South India. AIDS, 2013, 27:1449–1460.
[xix] Rachakulla HK et al. Condom use and prevalence of syphilis and HIV among female sex workers in Andhra Pradesh, India - following a large-scale HIV prevention intervention. BMC Public Health, 2011; 11 (Suppl 6): S1.
[xx] UNAIDS. 2000. Evaluation of the 100% Condom Programme in Thailand, UNAIDS Case Study.
[xxi] Halperin DT et al. A surprising prevention success: Why did the HIV epidemic decline in Zimbabwe? PLoS Med. 2011. 8;8(2).
[xxii] Johnson LF et al. 2012. The effect of changes in condom usage and antiretroviral treatment coverage on human immunodeficiency virus incidence in South Africa: a model-based analysis, Journal of the Royal Society Interface. 2012, 7;9(72):1544-54.
[xxiii] Stover J. 2014. Presentation. UNAIDS Global Condom Meeting, Geneva, November 2014.
[xxiv] In line with standard assumptions, 120 condoms are required for 1 couple year of protection. Projected condom sales for 2015 cited based on: Global Industry Analysts. 2014. Global Condoms Market. May 2014.
[xxv] Stover J et al. Empirically based conversion factors for calculating couple-years of protection. Eval Rev. 2000 Feb; 24(1):3-46.
[xxvi] Kennedy C et al. Is use of antiretroviral treatment (ART) associated with decreased condom use? A meta-analysis of studies from low- and middle-income countries (LMICs). July 2014 h International AIDS Conference. Melbourne, WEAC0104 - Oral Abstract Session.
[xxvii] Liu H et al. Effectiveness of ART and condom use for prevention of sexual HIV transmission in sero-discordant couples: a systematic review and meta-analysis. PLoS One. 2014 4;9(11):e111175.
[xxviii] Swiss AIDS Federation Advice Manual: Doing without condoms during potent ART. Swiss AIDS Federation, 2008.
[xxix] Fakoya A et al. British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection. HIV Medicine, 2008, 9: 681-720, 2008.
[xxx] Marks G et al. Time above 1500 copies: a viral load measure for assessing transmission risk of HIV-positive patients in care. AIDS 2015, 29:947–954.
[xxxi] WHO. 2015. Technical update on Pre-exposure Prophylaxis (PrEP), February 2015. WHO/HIV/2015.4.
[xxxii] WHO. 2007. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. WHO/UNAIDS Technical Consultation on Male Circumcision and HIV Prevention: Research Implications for Policy and Programming Montreux, 6 – 8 March 2007 Conclusions and Recommendations.
[xxxiii] WHO, UNFPA and Family Health International. 2013. Male Latex Condom: Specification, Prequalification and Guidelines for Procurement, 2010 revised April 2013.
[xxxiv] International Organisation for Standardisation. 2014. ISO 4074:2014 Natural rubber latex male condoms -- Requirements and test methods. http://www.iso.org/iso/catalogue_detail.htm?csnumber=59718.
[xxxv] Charania MR et al. Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998–2007. AIDS Behav, 2011, 15:1283–1297.
[xxxvi] Sweat MD et al. Effects of condom social marketing on condom use in developing countries: a systematic review and meta-analysis, 1990–2010. Bulletin of the World Health Organization 2012, 90:613- 622A. doi: 10.2471/BLT.11.094268.
[xxxvii] Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360 Advisory note. 2012.
[xxxviii]Source: Data from a database of Demographic and Health Surveys (DHS) available at statcompiler.com (verified January 2015).
[xxxix] Dusabe J, et al. “There are bugs in condoms”: Tanzanian close-to-community providers’ ability to offer effective adolescent reproductive health services. J Fam Plann Reprod Health Care 2015;41:e2.
[xl] Key populations are defined groups who, due to specific higher-risk behaviours, are at increased risk of HIV irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviours that increase their vulnerability to HIV. These guidelines focus on five key populations: 1) men who have sex with men, 2) people who inject drugs, 3) people in prisons and other closed settings, 4) sex workers and 5) transgender people. In consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. World Health Organization 2014.
[xli] Global Commission on HIV and the Law. Risks, Rights & Health. 2012
[xlii] UNAIDS. 2014. The Gap report.
[xliii] Open Society Foundations. 2012. Criminalizing condoms. How policing practices put sex workers and HIV services at risk in Kenya, Namibia, Russia, South Africa, the United States and Zimbabwe. http://www.opensocietyfoundations.org/reports/criminalizing-condoms.
[xliv] Bhattacharjya, M et al. The Right(s) Evidence – Sex Work, Violence and HIV in Asia: A Multi-Country Qualitative Study. Bangkok: UNFPA, UNDP and APNSW (CASAM). 2015.
[xlv] WHO; UNFPA; UNAIDS; NSWP; World Bank. 2013. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative intervention. 2013.
[xlvi] Vijayakumar G et al. A review of female-condom effectiveness: Patterns of use and impact on protected sex acts and STI incidence. International Journal of STD and AIDS, 2006, 17(10):652-659.
[xlvii] UNODC/WHO/UNAIDS. 2006. HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings A Framework for an Effective National Response.
[xlviii] UNODC/ILO/UNDP/WHO/UNAIDS. 2012. Policy brief. HIV prevention, treatment and care in prisons and other closed settings: A comprehensive package of interventions.
[xlix] Inter-Agency Standing Committee (IASC). 2003. Guidelines for HIV/AIDS interventions in emergency settings. Task Force on HIV/AIDS in Emergency Settings.
[l] UNFPA. 2015. Contraceptives and condoms for family planning and STI/HIV prevention. External procurement support report 2013.
[li] Foss AM et al. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sex Transm Infect 2007, 83:510–516.
[lii] Fossgard IS et al. Condom availability in high risk places and condom use: a study at district level in Kenya, Tanzania and Zambia. BMC Public Health 2012, 12:1030.
[liii] UNFPA-PSI. 2013. Total Market Approach Case Studies Botswana, Lesotho, Mali, South Africa, Swaziland, Uganda. http://www.unfpa.org/publications/unfpa-psi-total-market-approach-case-studies
[liv] Barnes, J et al. 2015. Using Total Market Approaches in Condom Programs. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates.
Update
Fast-Tracking the AIDS response for young women and adolescent girls in Africa
08 June 2015
08 June 2015 08 June 2015Considerable advances have been made in the global response to the AIDS epidemic over the last decades. Despite this progress, however, young women and adolescent girls in Africa are still being left behind.
In the sub-Saharan region, AIDS-related illnesses remain the leading cause of death among girls and women of reproductive age. In 2013, 74% of new HIV infections among African adolescents were among adolescent girls. Young women and adolescent girls acquire HIV on average five to seven years earlier than young men, and in some countries in the region HIV prevalence among this population can be as much as seven times that of their male counterparts.
In order to guide regional and global advocacy and inform political dialogue on HIV prevention and treatment among young women and adolescent girls, UNAIDS and the African Union have launched a joint report entitled Empower young women and adolescent girls: Fast-Tracking the end of the AIDS epidemic in Africa.
The document outlines three political commitments to advance the rights and empowerment of Africa’s young women and girls to help Fast-Track an AIDS response firmly rooted in gender equality and social justice. The commitments are to stop new HIV infections among young women and adolescent girls in order to ensure that AIDS is no longer the leading cause of death among adolescents; to empower young women and adolescent girls through comprehensive sexuality education; and to prevent HIV infections among children and keep their mothers alive.
The launch took place on 8 June as part of the 26th Gender is My Agenda Campaign pre-summit to the African Union meeting in Johannesburg, South Africa.
Quotes
“It is fitting that this report is launched here in Africa, as this is the epicentre of the global AIDS epidemic. It is here that we must Fast-Track our responses in order to help end AIDS as a public health threat by 2030.”
“The commitment to end the AIDS epidemic by 2030 cannot be attained unless a strategic and comprehensive focus is placed on young women and adolescent girls in every single African country.”
“In the absence of a vaccine, ending gender-based violence, keeping girls in school and empowering young women and adolescent girls are the best options we have available.”
“We need to educate our children to speak out and we need to speak to them their own language. They need to know that HIV is real. The best teacher is the mother and the best place to educate young women and girls is in the home.”
“As we work with our communities, our networks, our health service providers and our governments, we must commit to demanding a comprehensive focus on young women in the AIDS response.”
Related
U=U can help end HIV stigma and discrimination. Here’s how
27 February 2025
Zambia - an HIV response at a crossroads
24 February 2025
Documents
Empower young women and adolescent girls: Fast-Track the end of the AIDS epidemic in Africa
08 June 2015
Fast-tracking the end of the AIDS epidemic by 2030 requires strong political leadership and commitment to stop new infections and deaths among young women and adolescent girls and eliminate mother to child transmission of HIV. This requires building on, and extending Africa’s commitments on sexual and reproductive health and rights, expanding ministerial commitments on comprehensive sexuality education and stopping early marriage, adolescent pregnancy and expanding treatment service coverage.
Related
U=U can help end HIV stigma and discrimination. Here’s how
27 February 2025
Impact of community-led and community-based HIV service delivery beyond HIV: case studies from eastern and southern Africa
30 January 2025
Lost and link: Indonesian initiative to find people living with HIV who stopped their treatment
21 January 2025
Documents
69th GA: Report of the Secretary-General
29 May 2015
Related
U=U can help end HIV stigma and discrimination. Here’s how
27 February 2025
How the shift in US funding is threatening both the lives of people affected by HIV and the community groups supporting them
18 February 2025
Impact of community-led and community-based HIV service delivery beyond HIV: case studies from eastern and southern Africa
30 January 2025
Debrief
Using new media for the health and well-being of gay men and other men who have sex with men
22 May 2015
22 May 2015 22 May 2015New information and communication technologies are changing the way in which gay men and other men who have sex with men meet their sexual partners. Today, men who have sex with men, including those who are not openly gay or who fear stigma, are able to arrange to meet other men, look for entertainment, find health information and mobilize through dating applications, the Internet and other digital media.
Such technologies also represent an important resource for extending the reach and enhancing the effectiveness of HIV prevention programmes among gay men and other men who have sex with men. They hold the potential to drive measurable programmatic improvements by collecting and disseminating information, linking virtual content to physical services and complementing offline components of HIV programmes.
In order to improve the reach of HIV services and the impact of HIV prevention programmes, UNAIDS, in collaboration with the Global Forum on MSM & HIV, the USAID funded LINKAGES programme and Health Policy Project, organized a consultation to develop a framework to engage the private and public sectors and communities in using new media technologies for HIV prevention among gay men and other men who have sex with men.
Participants
The participants included experts in the area of new media and HIV among gay men and other men who have sex with men, including some of the largest private companies that own dating platforms, programme implementers, researchers and advocates.
Key messages
- A number of large, for-profit, gay dating applications and Internet companies with a very large number of clients already support initiatives to foster the health and well-being of their clients. They have the potential to reach people at higher risk of HIV infection with information and refer them to HIV service providers.
- Public–private partnerships on new media technologies for the health of gay men and other men who have sex with men need to be strengthened. A better understanding of the strengths and limitations of the private and public sectors as well as community organizations and networks is required.
- Innovative projects are increasingly using new information technologies to strengthen the HIV response among gay men and other men who have sex with men across the project cycle, from planning to implementation to monitoring and evaluation. These need to be evaluated and scaled-up.
- National AIDS programmes need to increasingly include the use of new information and communication technologies in their strategies and policies, build their own information and communications technology capacity and fund such programmes.
- Data safety issues need to be addressed.
- The use of new media should be included in core HIV packages and programmes; international guidance should be developed regarding minimum standards, training requirements or measures of success.
Quotes
“It's encouraging to see the United Nations reach out to emerging technologies to discover ways that our platform may help stop the spread of AIDS in the world.”
“It’s a rare opportunity to have the private sector, implementers and community all in the same room—there has been loud and clear message from this meeting that we do have the same goals, we do have the same concerns and we do share common ground from which it is possible to move forward together.”
“The evidence that information and communications technology have significant reach and offer considerable potential for public health and HIV prevention, especially in the field of mobile apps, is extremely encouraging.”
“I was thrilled to be part of this important consultation on building effective public–private partnerships to address sexual health issues of gay, bisexual and other men who have sex with men. We look forward to working more closely with the United Nations to find meaningful solutions in reducing HIV/sexually transmitted infections across the globe.”
“Undeniably, gay social networking applications can be a great tool. Blued, as a gay dating application with social responsibility, is keen to make our platform available for HIV interventions. We just need to learn how to work more effectively and innovatively.”
Partners
Update
Advancing the rights and autonomy of adolescent girls and young women
21 May 2015
21 May 2015 21 May 2015A lack of protection and promotion of young women’s and adolescent girls’ rights and autonomy continue to present a challenge to a Fast-Track approach to ending the AIDS epidemic, according to experts at a World Health Assembly side event held in Geneva, Switzerland.
Participants stressed how enhancing the availability of HIV services for adolescent girls and young women is not enough. Data show that less than 30% of currently married adolescent girls and young women aged 15–24 years have a final say regarding their own health care at the household level.
Age restrictions, including parental and spousal consent, inhibit access to HIV and sexual and reproductive health services. Furthermore, studies show that women who have been exposed to intimate partner violence are 1.5 times more likely to acquire HIV. Globally, 20% of the world’s married or partnered young women are estimated to have experienced physical or sexual violence by a partner in the past 12 months.
According to the participants, there are promising programmes that work to transform gender norms and reduce HIV incidence among young women and girls. For example, community programmes that focus on reducing partner violence and cash transfer programmes that provide girls with economic empowerment and autonomy.
Entitled Adolescent Girls’ Health: Approaches to Ensuring the Future She Deserves, the event was cosponsored by UNAIDS.
Quotes
“Every adolescent girl deserves our full investment right now to realize the healthy future she deserves, so that she can reach her full potential.”
“UNAIDS and partners are committed to ensuring that adolescent girls’ and young women’s sexual and reproductive health and rights are enshrined in our collective efforts to end the AIDS epidemic by 2030.”