Myanmar’s Minister for Health, Than Aung, confirmed during a meeting with the United Nations Secretary-General’s Special Envoy for AIDS in Asia and the Pacific, J.V.R. Prasada Rao, that domestic funding for HIV treatment will be increased by US$ 5 million. Mr Rao completed a five-day visit to Myanmar on 17 October, in which he focused on supporting the country’s efforts to rapidly and effectively scale up its AIDS programme.

There were 190 000 people living with HIV and 6700 new HIV infections in Myanmar in 2013. More than 65 000 people were receiving HIV treatment in 2013 and the Ministry of Health estimates the new funding will enable 40 000 additional people living with HIV to access antiretroviral medicine and will increase the national HIV treatment target coverage to 85%. The Minister of Health has asked his staff to work with UNAIDS to determine the cost of reaching 100% coverage.

Mr Rao welcomed Myanmar’s commitment to the HIV response and said, “The government is showing remarkable leadership in its national AIDS response and I ask the country’s leaders to extend strong support to the goal of ending AIDS by 2030. This goal must be a part of the sustainable development goals on health, which countries will adopt in 2015.”

The Minister of Health also pledged an additional US$ 1 million to further scale up opioid substitution therapy for 10 000 people by the end of 2016. Studies show that harm reduction programmes such as needle–syringe exchange programmes and opioid substitution therapy are effective in reducing the spread of HIV.

In Myanmar, key populations, including people who inject drugs, sex workers, men who have sex with men and transgender people, are at higher risk of HIV infection. Mr Rao urged the government to amend policies that violate the human rights of key populations and praised the country’s draft intellectual property law, which will help protect access to affordable medicines.

During his mission Mr Rao met other top officials, including the Attorney General, Tun Shin, the Deputy Minister for Home Affairs, Kyaw Kyaw Htun, and the Deputy Minister of Foreign Affairs, Thant Kyaw. He also met with Aung San Suu Kyi, Chairperson of the National League for Democracy and Member of Parliament, who expressed her support for efforts to reform laws and policies.  

Mr Rao also met civil society representatives from key populations while participating in a panel discussion on the sustainable development goals and HIV. 

A new report on Tuberculosis (TB) released on 22 October by the World Health Organization shows that 9 million people developed TB in 2013, and 1.5 million died, including 360 000 people who were living with HIV.

The Global Tuberculosis Report 2014 highlights that while the number of TB deaths among people living with HIV has been falling for almost a decade—from 540 000 in 2004 to 360 000 in 2013—early case detection, antiretroviral treatment, preventive therapy and other key activities need to be further scaled-up.

According to WHO, one of the keys to reducing the number of deaths from HIV-associated TB is early case detection through the provision of HIV testing to all TB patients and routine TB screening among people attending HIV care. In 2013, 48% of TB patients had a recorded HIV test result and only half of those estimated to be co-infected with HIV-related TB were identified. Since 2012, WHO has recommended antiretroviral therapy (ART) for all TB patients testing positive for HIV within the first 8 weeks of initiation of TB treatment (and within 2 weeks of TB treatment for TB patients with profound immunosuppression). From 2012 to 2013, HIV treatment coverage among recorded TB patients rose encouragingly from 60% to 70% but this still represents less than a third of those estimated to be living with both TB and HIV.

Uptake of isoniazid preventive therapy (IPT)—which prevents people living with HIV from developing active TB—is rising slowly, the report finds. However, while the provision of IPT is increasing in Africa, only 21% of countries globally and 14 out of the 41 high burden TB/HIV countries reported provision of IPT to HIV positive people in 2013.

The implementation of collaborative TB/HIV activities has not evolved evenly across countries. The report stresses that further scale up of collaborative TB/HIV activities could be facilitated by joint TB and HIV programming, which would help to overcome constraints, promote synergies and achieve efficiency gains, especially between TB and HIV programmes.

WHO recommendations on the activities needed to prevent TB in HIV-positive people and to reduce the impact of HIV co-infection among HIV-positive TB patients have been available since 2004. These include establishing and strengthening coordination mechanisms for delivering integrated TB and HIV services; HIV testing for all patients with presumptive and diagnosed TB, providing antiretroviral therapy and co-trimoxazole preventive therapy to all HIV-positive TB patients, providing HIV prevention services for TB patients, intensifying TB case-finding among people living with HIV, offering IPT to people living with HIV who do not have active TB, and preventing the transmission of TB infection in health care and congregate settings.

The report concludes that despite encouraging progress, reaching the global target of halving deaths from HIV-associated TB is at risk, if countries don’t intensify the collaborative HIV/TB activities.

Anywur Mayan took her first HIV test two years ago. A health worker came to her house in rural Jonglei State and briefly explained that he was checking her for a virus. He pricked her finger and drew some blood. A few minutes later he told her the test had come back negative and left.

She did not really learn what HIV is or how it is spread until early June this year, after she had moved hundreds of miles from her Jonglei home to escape fighting there. Her new settlement Nimule—a border town near South Sudan’s border with Uganda—is safer, but has much higher HIV prevalence.

Behind there, there is nothing,” said Anywur, pointing in the direction of Jonglei. “Our houses, our belongings, they were all destroyed.

Fighting broke out in the South Sudanese capital, Juba, in mid-December and spread rapidly across nearly half the country. The United Nations Office for the Coordination of Humanitarian Affairs estimates that tens of thousands of people have been killed and more than 1.7 million have fled from their homes since December 2013—about 1.3 million displaced internally and 448 000 seeking refuge in neighbouring countries.

Raising awareness

Anywur, with her husband and infant son, set out in January for Nimule, where the HIV prevalence—estimated at 4.4%, according to the 2012 Antenatal Clinics Surveillance Report—is well above the national average of 2.6%.

In Anywur’s new home in Nimule a collection of local organizations has taken on the task of raising awareness about HIV. Anywur said she only found out what HIV is when a team of community educators gave a detailed presentation about the virus with the aid of information, education and communication materials created by the South Sudan AIDS Commission (SSAC) and UNAIDS.

Where we came from, this kind of education, it is not there,” she said.

But local activists and health workers said they still have thousands more people they need to reach and not enough resources to do it. At the same time, the new arrivals add a layer of complexity to the work they were already doing in the community.

HIV services

The highway connecting Juba to Uganda and the rest of eastern Africa cuts through Nimule, which hosts the country’s most active border crossing. Overloaded trucks rumble through the town at all hours, carrying fruits and vegetables, mattresses and anything else that can be sold in Juba’s markets.

Like many border towns, Nimule has its share of sex workers and their clients, especially long-distance truck drivers. The 2013 South Sudan Global AIDS Response Progress Report estimates that 62.5% of all new adult HIV infections in the country last year arose from sex work, the majority being clients of female sex workers.

Before the fighting broke out, Patrick Zema, Nimule Hospital’s HIV testing and counselling supervisor, said they were making significant progress in increasing awareness about the virus, reducing stigma and linking people to services. The hospital currently has 1 300 clients enrolled in antiretroviral therapy.

But now they are starting from the beginning with the displaced communities. “They come and they fear to test their blood,” said Pascalina Idreangwa Enerko, the chairperson of the local Cece Support Group of People Living with HIV, who attributes this behaviour to a combination of a lack of knowledge about the virus and stigma that comes with an HIV-positive diagnosis. “Thanks to the health education provided, they come out. It is important that they know their status.

Since April, Cece has teamed up with two community-based organizations—Humans Must Access Essentials (HUMAES) and Caritas Torit—to do near-daily mobile awareness-raising campaigns within the far-flung displaced community.

The community mobilizers begin with an hour-long presentation on HIV awareness and prevention. Then they encourage people to visit different stations, including one for paediatric consultations, a free drug dispensary and an HIV testing centre.

Reena’e Awuor Ondiek, Caritas Torit’s HIV counsellor, said her table was not popular when they first started in February, but she has noticed a change in people’s attitudes as she has made repeated visits to the same communities.

The programme has also helped address one of the other major challenges created by the crisis. “The conflict moved people from one place to another and interrupted follow up,” said Habib Daffalla Awongo, SSAC’s director general for programme coordination. “Some patients have been lost within host populations.” During their community visits, a Caritas team has already located people who stopped treatment as they fled the fighting and restarted them on antiretroviral therapy.

The team is still facing challenges, the most critical being a shortage of money. They are unable to hire the vehicles they need to reach thousands of displaced people who are camping outside of Nimule and who have almost no access to HIV services.

But Ondiek said there is no shortage of people like Anywur who need their services in the communities they can reach.

Among the cattle, helicopters and bands, the 88th Agricultural and Commercial Show of Zambia lived up to its 2014 theme: “Breaking new ground”—with a lively HIV prevention exhibit.

The trade show served as the stage for UNAIDS and its partners to reach young people with information and services aimed at preventing sexually transmitted infections and HIV.

Each day, more than 80 000 young people attended the trade show, which was held in Lusaka from 30 July to 4 August 2014.  

The UNAIDS office in Zambia brought together popular bands and service providers so that young people could get information on sexual reproductive health and services in an adolescent friendly way. 

Bands from Lusaka and provinces across the country drew large crowds with fun and energetic performances. Musicians playing at the Band Stand, the most popular arena among youth, delivered prevention messages. They also promoted individual responsibility for protecting themselves and their partners.

“The success of our joint initiative highlights that when young people can act immediately on the messages they hear and access services, they are more than willing to do so,” said Helen Frary, UNAIDS Country Director for Zambia. “Providing these services in an environment they identify with can go a long way in stopping stigma.”

Voluntary counselling and testing services and male and female condoms were readily available near the stage. Led by the United Nations Population Fund, the Condomize! Campaign drew attention to the fact that a low rate of condom use is one of the reasons behind HIV infections in Zambia. More than 120 000 condoms were distributed free of charge with UNAIDS support.

“It is refreshing to see young people taking condoms without fear or diffidence,” said Clementine Mumba of the Condomize! campaign.  

More than 1096 people got counselling and testing through the Society for Family Health and the Community for HIV/AIDS Mobilization Program. The number of people who received counselling and testing exceeded expectations, with providers running out of test kits midway through the last day of the event.

The United Nations Children’s Fund called on adolescents and young people present at the event to join its Zambia U-Report SMS platform and interact with counsellors via text messages on issues related to sexual health and HIV. New members topped 2200. 

Now a 19-year-old university student in South Africa, Noxolo Myeketsi started receiving a social welfare grant in 2005. Part of a state-run programme to assist poor households, the cash transfers allowed her to stay in school and her grandmother to buy food and pay their bills.

The grant changed Noxolo’s life for the better. Other girls turned to having sex, often with older men, in exchange for basic needs, and potentially exposed themselves to sexually transmitted infections and HIV.

“I believe that without the grant assistance, I would not have been able to make healthy decisions in my life. Maybe I would have ended up being a sugar daddy’s girl, like others from my area, or ended up contracting HIV,” Noxolo said.

Social protection schemes, including financial incentives, can make a difference in a number of ways. The World Bank reports that, globally, there is strong evidence that cash transfers improve the education, health and lifelong income of beneficiaries. 

“Cash transfer programmes work for HIV prevention and a host of other human development outcomes as well, and they are scalable,” said David Wilson, Director of the World Bank’s Global HIV/AIDS Program.

Studies conducted in South Africa show that small cash grants provided to poor households allow teenage girls to make safer sexual choices and can significantly reduce the number of new HIV infections. When psychosocial care and support are added to the cash, the results for girls are even better.

At the UNAIDS Programme Coordinating Board (PCB) meeting held in Geneva in July a thematic session was organized on addressing the social economic drivers of HIV through social protection, at which Noxolo spoke about the positive impact grants can have.

Following up on the PCB meeting, UNAIDS and the World Bank pledged to assist governments in the process of scaling up social protection programmes, including cash transfers, for HIV prevention in eastern and southern Africa, covering Botswana, Kenya, Lesotho, Malawi, South Africa, Swaziland, United Republic of Tanzania and Zambia.

“It is befitting that South Africa is the centre of the initiative because the country accounts for 23% of sub-Saharan Africa’s new HIV infections, 18% of the global HIV burden and has one of the world largest social protection programmes,” said Benjamin Ali, UNAIDS Country Director for South Africa.

Countries and partners will be urged to collaborate in a comprehensive review of social protection systems. Proposals to make such systems HIV sensitive include modifying age bands and other inclusion criteria to ensure that the groups most affected and at risk of HIV infection are covered, providing some cash directly to girls and young women and linking cash incentives to their adherence to HIV prevention and treatment programmes.

UNAIDS Executive Director Michel Sidibé recently visited a centre in Moroni that primarily provides antenatal care for pregnant women and prevention of mother-to-child transmission of HIV. It is run by the Association comorienne pour le bien-être familial (ASCOBEF), a nongovernmental organization.

At the centre, women have access to health services early in pregnancy and are offered an HIV test so that, if they need it, they can get treatment for themselves and appropriate postnatal care for their infants. The work ASCOBEF does at the centre highlights the critical role that civil society plays in supporting the Government of the Comoros in its response to HIV.

During his visit, Mr Sidibé had the opportunity to meet with members of civil society whose organizations conduct HIV counselling and testing, awareness-raising and community mobilization. They discussed their activities and the challenges they face in providing comprehensive care for people living with HIV, including the limited support they get from other sectors.

“We must not tolerate the shrinking of a democratic space of nongovernmental actors. The role of civil society is essential,” said Mr Sidibé.

Mr Sidibé reiterated the important role of civil society in advocating a human rights approach, especially in the context of the post-2015 development agenda and the rights and gender action that is needed to ensure that no one is left behind.

At the 2014 International AIDS Conference in Melbourne, Australia, one of the questions being asked is: “Where should the world focus its attention in the AIDS response?” 

In the recent Gap report, UNAIDS highlighted the importance of location and population. The report shows that 15 countries account for more than 75% of the 2.1 million new HIV infections that occurred in 2013. The countries—Brazil, Cameroon, China, India, Indonesia, Kenya, Mozambique, Nigeria, Russian Federation, South Africa, Uganda, United Republic of Tanzania, United States of America, Zambia and Zimbabwe—can all make a positive impact by scaling up HIV services where they are most needed to reduce new HIV infections.

This was one of the issues highlighted by the UNAIDS Executive Director, Michel Sidibé, when he met with Nafsiah Mboi, the Minister of Health of Indonesia—which is working to increase access to HIV testing and early treatment—at the conference.

“I know that Indonesia can quickly change the trajectory,” said Mr Sidibé. “The government is committed and has the capacity to accelerate scale-up and I expect we will see the results soon.”

Countries often face multiple epidemics and hence there is an increased urgency to focus at the city and district level in order to effectively reach the people currently being left behind.

“Countries with the highest burden have to do the heavy lifting to end the AIDS epidemic and provide services to all affected people—location by location, population by population,” said Mr Sidibé.

Populations at higher risk of HIV infection are often difficult to reach. India has sustained investments in key populations for more than a decade and expanded outreach in more than a thousand locations within the country. In the Russian Federation, despite clear scientific evidence of the impact of harm reduction services, very few people who inject drugs have access to opioid substitution therapy and needle–syringe programmes.

Brazil, which has been a pioneer in the AIDS response, has recently seen HIV infections rise among young gay men and other men who have sex with men. Health authorities and civil society groups in Brazil are exploring innovative new ways to get life-saving information and treatment to a new generation of young men who may not know they are at higher risk of becoming infected.

In Mozambique, new data analysis shows that the districts with the highest density of people living with HIV are located along transport corridors and in important seaports in the central and southern regions of the country, and the country is now beginning to expand access to HIV services in these areas.

In Nigeria, a similar analysis led to a focus on 13 states, including the Federal Capital Territory, which includes Abuja, for intensifying scale-up. South Africa, the country with the largest number of people living with HIV, has made significant gains in stopping the AIDS epidemic. A national HIV testing campaign, combined with intense civil society engagement, led to more than 2.5 million people having access to antiretroviral therapy.

“This is why the exchange of ideas is so important,” said Mr Sidibé. “When we can share data and best practices, we can close the programmatic gaps.”

The 20th International AIDS Conference opened in Melbourne, Australia, on 20 July 2014 with a moving and powerful range of statements from leading figures in the response to HIV. The ceremony was dedicated to the memory of the victims lost in the international tragedy—several of whom were on their way to participate in AIDS 2014.

Nobel laureate and President of the International AIDS Society Professor Françoise Barré-Sinoussi paid tribute to the friends and colleagues who died. “We dedicate AIDS 2014 to them, we will remember their legacy and keep them in our hearts,” she said.  

Michel Sidibé, Executive Director of UNAIDS, gave an inspiring address calling for an end to the AIDS epidemic by 2030 and stressed the need for a new “catch-up” plan to leave no one behind. “Now, more than ever, we must concentrate our limited resources on where most infections occur and on where most people die,” he said. “The world needs a new “catch-up” plan for the 15 countries that account for 75% of new HIV infections.”

UNAIDS Goodwill Ambassador and Master of Ceremony James Chau guided the speakers through the special memorial opening session. He extended a warm welcome to Ayu Oktariani, a young woman living with HIV from Indonesia, who spoke passionately about the challenges she faces in her daily life, “Living with HIV is not easy,” she said. “It's not only about HIV; it's about people’s judgement of my sexual behaviour.” She talked about discriminatory attitudes of health-care workers and the lack of information on sexual and reproductive health. “Many of us have HIV because we did not have the means or information to protect ourselves,” she added.

Co-chair of AIDS 2014 Professor Sharon Lewin told the participants how important the conference was to Australia and the world. A sentiment echoed by the Premier of the State of Victoria, Denis Napthine, “This conference is about stepping up the pace, making a difference and making the world a better place,” he said.

Aboriginal Elder Joy Wandin Murphy extended a warm welcome to Australia to all the participants. She talked about the country’s past struggles and stressed the importance of tolerance and acceptance. “If we understand each other we can live in harmony, and, if we do, we can eliminate stigma and discrimination so we can all live together.”   

The Jonathan Mann memorial lecture was given by Justice Michael Kirby, who strongly emphasized the importance of equality and justice for all. He talked about the impact of punitive laws and the devastating impact they can have on people living with and affected by HIV. He stressed that, “Law and policy must be made part of the solution and not part of the problem for AIDS.”

The United Nations Secretary-General Ban-Ki moon and the Prime Minister of Australia Anthony Abbott delivered video messages expressing their sorrow for all who died on flight MH17 and encouraged participants to take the opportunity provided by the conference to advance the response and reach the end of the AIDS epidemic.

Deputy Prime Minister of Australia Warren Truss stated that Australia will pursue an ambitious commitment to ending AIDS as part of the post-2015 agenda. The event was closed by a concert from Dan Sultan.

The 20th International AIDS Conference will run from 20 to 25 July in Melbourne, Australia. The delegates will review and present the latest scientific findings as well as the social and structural innovations and challenges in the AIDS response.

AIDS 2014 opened overshadowed by an international tragedy. During a ceremonial inauguration to welcome the conference participants to the city, the organizers expressed deep sadness for the loss of the many delegates travelling on flight MH17. 

Speakers at the event stressed the importance of honouring the legacy of the researchers and AIDS advocates who died by increasing efforts and commitments to pursue their cause. “It is a difficult moment. We lost friends, activists and people who are the voice of the voiceless,” said UNAIDS Executive Director Michel Sidibé.

The Premier of Victoria, Denis Napthine, said, “This is a massive loss to our community, who worked together across the world to tackle HIV.”

Mr Sidibé participated together with the Lord Mayor of Melbourne, Robert Doyle, and the co-chair of the AIDS 2014 conference, Sharon Lewin, in the lighting of the AIDS 2014 sign event. Messages from international leaders, including President Barack Obama, the Lord Mayor of Melbourne, and the Mayors of Milan, Osaka, Tianjin and Thessaloniki, were projected onto the façade of the Arts Centre Melbourne’s Hamer Hall. Mr Sidibé’s message read “Ending AIDS is the only dream we should all have.”

The 20th International AIDS conference will take place from 20 to 25 July in the Australian city of Melbourne under the theme “Stepping up the pace”.

AIDS 2014

Delegates from all over the world will participate in a series of sessions, panels and community-led discussions to take stock of the progress made, analyse the latest scientific advances and mobilize governments and communities to chart the way forward to end the AIDS epidemic.

This year’s theme recognizes the many advances made in the past few years in the areas of vaccine research, the growing number of people receiving antiretroviral therapy and the falling number of new HIV infections. However, “Stepping up the pace” also stresses the need to keep HIV as a priority in the global agenda and that more investments, collaborative research and political commitment are needed to ensure that no one is left behind.

UNAIDS Executive Director Michel Sidibé will be among the high-level speakers participating in the conference, together with President Bill Clinton and artist and activist Bob Geldof. UNAIDS will be participating in a number of events before and during the conference, including the preconference sessions on youth, men who have sex with men, and interfaith communities, as well as other sessions on HIV treatment, adolescents, prevention of mother-to-child transmission and human rights, among others.