If the world is to effectively reduce poverty and reach key development goals in critical areas such as health and education, countries need to focus not only on achieving growth as an end in itself but on implementing policies that allocate resources to those who are extremely poor. This is the central message of a recent major World Bank paper that explores how nations can enhance shared prosperity and ensure that growth is of benefit across the board. 

Prosperity for all, ending extreme poverty highlights the World Bank Group’s two bold goals to be achieved: eradicating extreme poverty so that no more than 3% of the global population live on less than US$ 1.25 a day; and raising income growth among the bottom 40% of earners.  

World Bank Group President Jim Yong Kim recognized the hugely ambitious nature of the goals, but maintained that they can be reached with increased commitment and the right interventions. “To end extreme poverty, the vast numbers of the poorest … will have to decrease by 50 million people each year until 2030. This means that 1 million people each week will have to lift themselves out of poverty for the next 16 years. This will be extraordinarily difficult, but I believe we can do it. This can be the generation that ends extreme poverty.”

Growth alone is unlikely to end extreme poverty by 2030 given that, according to the report, as poverty falls growth tends to lift fewer people out of poverty: when growth occurs many of the lowest income earners are in such difficult situations that ameliorating their lives is very hard. So, identifying and focusing on the bottom tiers, in country-specific ways, is considered crucial to making sure that the world’s 1.2 billion poor are not left behind and can fulfil their potential, benefitting themselves, their communities and their nations. (Five countries, Bangladesh, China, Democratic Republic of the Congo, India and Nigeria, are home to nearly two thirds of the poor, nearly 760 million people.)

The paper also warns of the dangers of not tackling income inequality. In countries where it is rising, the effect of growth on poverty has been slowed or in some cases reversed.

Prosperity for all, ending extreme poverty suggests that the twin goals, critical to the post-2015 development agenda, can be achieved through promoting more inclusive growth and through proactive programmes, such as conditional and unconditional direct cash transfers, which have been shown to have a significant impact on education, employment and health outcomes. To achieve sustainable development it is seen as vital not simply to lift people out of extreme poverty, but, as the report contends, “It is also important to make sure that, in the long run, they do not stagnate just above the extreme poverty line due to lack of opportunities to continue to move toward better lives.”

The World Bank Group has acknowledged that HIV, inequality and extreme poverty are inextricably linked and need to be tackled jointly. Earlier in 2014, the Bank, alongside UNAIDS, committed to four areas of action, which include aligning health and development efforts towards ending extreme poverty and AIDS and urging the post-2015 development agenda to include targets towards ending AIDS, as well as the goal of universal health coverage, so that no one falls into poverty or is kept in poverty due to payment for HIV treatment or health care. There is also a commitment to promoting national and global monitoring and implementation research.

According to the paper, such monitoring and mapping on a wider socioeconomic scale will be essential to see the World Bank Group’s overarching twin poverty eradication goals become reality. More and better data will be required so that interventions can be evidence-informed and progress monitored. This research will help the world’s policy-makers attain more inclusive growth and ensure that sustainable prosperity is shared and that the bottom 40% can benefit from the full range of economic and development gains.

Former Chairman and Chief Executive Officer of MTV Networks International Bill Roedy reached the top of Africa’s highest mountain on 12 April and demonstrated his solidarity with UNAIDS and global partners working in the AIDS response.

“We trekked through the huge temperature fluctuations and intense fog and sun radiation of the desert,” said Mr Roedy. “With your inspirational support and incredible generosity we successfully reached the summit of Mount Kilimanjaro.”

“MTV brought a great opportunity for us to communicate with young people in an entertaining and meaningful manner. I am very proud that Mr Roedy continues to inspire young people and the world both in his professional and personal life,” said UNAIDS Executive Director Michel Sidibé.

Since 1996, MTV has had a long-standing partnership with UNAIDS and its Cosponsors. In 1998, MTV created the Staying Alive campaign—a multimedia global campaign against HIV.

The successes of the campaign led to the formation of the Staying Alive Foundation, which provides financial and technical support to young people working on innovative HIV prevention programmes on the ground and broadcasts original content to help spread HIV awareness around the world.

In May 2010, a three-part TV drama—Shuga—commissioned by MTV Networks Africa won a Gold award at the World Media Festival in Hamburg, Germany, in the Public Relations Health category. Shuga was based on a story about a group of young friends living in Nairobi, Kenya, and includes messages about HIV prevention for young people.

From the headquarters of MTV to the 120 km/hour winds of Mount Kilimanjaro, Mr Roedy continues to advocate for the response to HIV.

“Everybody experienced some form of altitude sickness. We battled through vomiting, tears, windburn, knee pain, freezing cold hands and feet and complete exhaustion at the end, but somehow, we managed to reach Uhuru Peak, said Mr Roedy. “Having all of your support made all the difference.”

Despite the unprecedented progress made in the AIDS response in recent years, emerging evidence suggests that adolescents are falling behind as a result of not receiving the attention and services they require.

AIDS-related mortality among adolescents has increased by 50% over the past seven years, but fell for all other age groups, according to UNAIDS estimates. Two out of three people aged 0–14 lack access to HIV treatment worldwide, and recent data collected from sub-Saharan Africa indicate that only 10% of young men and 15% of young women (15–24 years) are aware of their HIV status.

To advance the adolescent treatment and care agenda, UNAIDS, the International Treatment Preparedness Coalition, the Global Network of People Living with HIV/AIDS (GNP+) and PACT brought together key treatment actors, United Nations and youth organizations and networks of young people living with HIV. During the two-day meeting, held on 16 and 17 April, participants analysed the main obstacles affecting adolescents in the AIDS response and charted an action agenda to ensure that adolescents are not left behind.

There is an urgent need to ensure that adolescents living with HIV become aware of their status and have access to effective HIV treatment and quality care programmes. Furthermore, adolescents face particular challenges to adhere to HIV treatment, lack support to disclose their status and there is an absence of information about their sexual and reproductive health and rights.

There are many reasons why adolescents may stop taking their HIV medications regularly, including their side-effects, “treatment fatigue”, self-stigma or a lack of community support. However, maintaining adherence to HIV treatment is one of the key elements for optimizing health outcomes for adolescents living with HIV. Besides its primary health benefits, taking antiretroviral treatment correctly and consistently delays the development of drug resistance and contributes to preventing the onward transmission of HIV.

“We cannot achieve zero AIDS-related deaths and zero new HIV infections if we don't focus on addressing the unique treatment needs of adolescents,” said Bactrin Killongo, from the International Treatment Preparedness Coalition. “For me, the agenda of scaling up HIV treatment should start with adolescents, especially those who were perinatally infected.”

Many adolescents living with HIV have also expressed lack of support regarding how, when and with whom to disclose their HIV status. This can lead to anxiety and depression. For members of young key populations, the situation is even more difficult, as they often face discrimination on account of the behaviour that makes then vulnerable to HIV, such as sex between men, as well as their HIV-positive status.

“Where do you go when you are discovering your sexuality as an adolescent? Very often the challenge that we face as young gay men is the double disclosure,” said Pablo Aguilera, Executive Director of the HIV Young Leaders Fund. “You have to tell people around you that you are HIV-positive and that you are gay, and this can get much more complicated when homosexuality is criminalized in your country and when you need the consent of your parents to access health care!”

Comprehensive sexuality education that is specifically catered to the unique needs of adolescents living with HIV is missing from most school and health-care settings globally. Many adolescents living with HIV are therefore left to deal with sexuality and relationships entirely on their own, leaving them isolated and fearful of sex and sexuality, while others lack sexual and reproductive health information and skills around safe sex.

“There is a need to tackle HIV prevention and treatment simultaneously and holistically among adolescents, recognizing not only their treatment and clinical needs but their emotional, physical and sexual needs too,” said Musah Lumumba, a young man living with HIV and Y+ member from Uganda.

Stigmatizing attitudes from health-care workers in relation to adolescents who are sexually active are also persistent. “As a young woman living with HIV, we often face challenges with access to sexual and reproductive health and services and adherence to HIV treatment, due to mistreatment and stigma from health-care workers,” said Consolata Opiyo, from the International Community of Women Living with HIV/AIDS. 

A call to action

After two days of intense conversations, the participants identified core priorities to move the agenda forward, including developing a network to advance an agenda for adolescents to access medicines, demanding better treatment services at the country level, with a particular focus on national antiretroviral therapy guidelines and Global Fund to Fight AIDS, Tuberculosis and Malaria proposals, implementing a science agenda to fill the current research gaps regarding adolescents living with HIV and developing a mechanism to support the scaling up of programmes around adolescents living with HIV that work.

“This is a watershed moment in the AIDS response,” said Linda-Gail Bekker, Professor of Medicine and Deputy Director of the Desmond Tutu HIV Centre. “We now have a critical mass of organizations working jointly to advance the adolescent treatment and care agenda!”

The outcome document from the meeting will be available ahead of the World Health Assembly in May 2014.

In 2006, the Government of Mauritius started harm reduction programmes—needle exchange programmes and opioid substitution therapy (methadone)—to reduce the transmission of blood-borne infections among people who inject drugs both inside and outside prison. Government figures from 2012 show that more than 5 400 people were enrolled on opioid substitution therapy, and the Global AIDS response progress report for Mauritius for 2012 shows that HIV transmission through injecting drug use in Mauritius declined from 73% in 2010 to 68% in 2011.

During an official visit to Mauritius, UNAIDS Executive Director Michel Sidibé visited the Central Prison in Beau-Bassin, Mauritius’s largest prison, to learn about its opioid substitution programme, which allows inmates to continue receiving a daily dose of methadone while imprisoned.

During the visit, Mr Sidibé commended the Government of Mauritius and nongovernment organizations for putting in place a programme that ensures the well-being of inmates. “The quality of the treatment of prisoners reflects the level of humanity in Mauritius,” said Mr Sidibé. “The Central Prison in Beau-Bassin is restoring human dignity in all its dimensions.”

Government figures show that in March 2014 an estimated 2 289 convicted and remand detainees were held in nine prisons in Mauritius. Almost 40% of male inmates in the country are imprisoned due to drug-related crimes, and 30% of inmates are living with HIV. Sharing of smuggled injecting equipment is common in jail, which increases the risk of HIV infection while in custody.

Mauritius is proud to be among the few countries to implement a methadone programme in prison, which covers more than 200 inmates,” said Jean Bruneau, Commissioner of Prisons in Mauritius. “Because of this programme, Mauritius has been able to reduce HIV transmission among prisoners who use drugs.”

“I am grateful to the government for supporting the methadone programme and other important services at the prison care centre,” one prison inmate told Mr Sidibé. “This is preparing me to get back to a normal life and be a valued member of my community.”

During his visit to Mauritius, Mr Sidibé also met with representatives of civil society organizations and networks of people living with HIV to discuss opportunities and challenges in the national AIDS response.

“My discussion with civil society was a moment of truth, an exchange that brought a face to the epidemic,” said Mr Sidibé. “As we look to our post-2015 goals, we must make sure that no one is left behind.”

Stigma and discrimination towards people living with HIV remain critical to the national AIDS response. The People Living with HIV Stigma Index shows that in Mauritius 30% of respondents—people living with or affected by HIV—had fears about being insulted or verbally threatened or harassed, while 23% feared physical assault. Additionally, 28% of respondents reported being denied access to health services due to HIV, while 40.5% reported discriminatory or very discriminatory responses to disclosures of their HIV status to health-care workers.

“People are stigmatized and discriminated because of their HIV status—they are continuously denied services, excluded from their communities and face the threat of deportation. These are the realities of people living with HIV in Mauritius,” said Nicolas Ritter, Executive Director of Prévention Information et Lutte contre le SIDA.

The Caribbean response to HIV has known many successes in recent years. Since 2001 there has been a 54% decline in AIDS-related deaths while new HIV infections have dropped by 49%. Twenty times more people are accessing HIV treatment now than there were ten years ago. And several countries are on track to virtually eliminate new HIV infections among children by 2015.

However, stigma and discrimination are still hampering efforts to reduce new HIV infections, increase the numbers of people accessing antiretroviral treatment and ensure that all people living with HIV can live full and productive lives. Prejudice towards people living with HIV and other key populations such as men who have sex with men, transgender people, sex workers, people who use drugs, homeless people and prisoners, remains a major obstacle throughout the region.

“HIV is a by-product of social inequities,” said Carolyn Gomes, Executive Director of the Caribbean Vulnerable Communities Coalition at the Caribbean Consultation on Justice For All in Kingston, Jamaica. “We need a bottom-up approach. We have to find ways to be heard. We have to apply resources to what we know would bring about transformative change.”

The “Justice For All” initiative is meant to link the voices and actions of members of civil society with governments, faith communities and the private sector. It is an attempt to collectively propel Caribbean countries toward improving citizens’ access to justice and equity. It also aims to build alliances in order to increase awareness and support for human rights.

Coordinated by the Pan-Caribbean Partnership Against HIV and AIDS (PANCAP), the effort is led by the United Nations Secretary General’s Special Envoy on HIV for the Caribbean, Professor Edward Greene, supported by UNAIDS.

“The world now knows what to do to end this epidemic,” UNAIDS Deputy Executive Director, Luiz Loures told participants. “We have the tools but we have entered a phase in which some people are getting left behind. The Caribbean is part of this contradiction. The general epidemic is going down but there are still laws, attitudes and practices that stop us from achieving our goals.” Dr Loures encouraged participants in the consultation to choose concrete targets and milestones to chart their progress towards ending stigma and discrimination.

The Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, Mark Dybul, noted that this regional approach to building a culture of respecting human rights is unique. "The Caribbean can become the leader in ending AIDS,” said Mr Dybul. “We are at an historic moment when we can end AIDS as a public health threat. No other epidemic is pushing us to respond to one another differently and to embrace everyone, every small subset of people, as part of the human family.”

Mr Greene identified key areas of focus including reducing gender inequality, promoting sexual and reproductive health and rights and repealing discriminatory laws that infringe human rights. Sex between men is a criminal offence in 11 nations in the region and several Caribbean countries prohibit aspects of sex work. Some countries also have laws that restrict entry on the basis of sexual orientation, HIV status and disability. The Prime Minister of St. Kitts and Nevis, Denzil Douglas, assured that “Justice For All” will be a focus of discussion for the region’s political leaders. 

Cricket players from around the world are once again showing their support to young people living with HIV as part of the global Think Wise partnership on HIV.

Throughout the International Cricket Council (ICC) 2014 World Twenty20 (WT20) tournament—which runs in Bangladesh until 6 April—cricketing stars from a variety of international teams are taking part in coaching sessions and site visits. They are meeting with young people living with and affected by HIV, raising awareness of the importance of accessing HIV information and services.

The Think Wise initiative is a long-running partnership between ICC, UNICEF and UNAIDS that uses the power of cricket to reach out to large numbers of people on HIV issues. The partnership, which emphasizes messages on HIV prevention and the need for the elimination of HIV-related stigma and discrimination, has been profiled throughout the 2014 WT20. Players and match officials have worn red ribbons in solidarity with people living with HIV and Think Wise messages are profiled in the stadiums.

As part of the Think Wise activities carried out in Bangladesh, players from the Australia, Bangladesh, West Indies and South Africa teams held special cricket coaching sessions and events for children and young people. As well as practical cricket instruction from the players, the young participants spent additional time with them discussing HIV and life skills issues. Young participant Pranto Sarkar, aged 11, underlined his excitement at having time with the cricketing stars to play with and learn from them. “I just can’t believe that I have played with them, for me it’s a dream come true,” he said.

A special site visit was arranged for members of the Bangladesh women’s international team to the Ashar Alo Society, an organization of people living with HIV. Players met children living with and affected by HIV, who shared their stories about the challenges they face.

Stressing the importance of partnership with the Bangladesh National AIDS Programme, the Bangladesh Cricket Board and the civil society partners that helped to facilitate events, trainings and site visits, the Chief of HIV at UNICEF Bangladesh, Dr Tajudeen Oyewale said, “The events in Bangladesh are a demonstration of the effective power of sport in reaching adolescents with HIV prevention information. The uniqueness of the training lies in the integration of HIV messages into cricket training drills, as well as the broad partnership between UNICEF, UNAIDS and ICC, and the national partners.”

Think Wise has inspired many leading cricketers to join efforts to promote HIV prevention and reduce HIV-related stigma and discrimination. For the 2014 WT20, Bangladesh international all-rounder Shakib Al Hasan championed Think Wise—speaking about HIV prevention and stigma at a number of public events, starring in a Think Wise public service announcement that was shown in cricket grounds throughout the tournament and taking part in the in-tournament Think Wise activities with his colleagues.

“I feel privileged to be a part of the Think Wise campaign. As a sportsperson I know how far-reaching an impact we can make in addressing key issues around HIV, especially in developing countries like Bangladesh,” said Mr Al Hasan.

Commenting on the importance of the involvement of sports stars in the profiling and dissemination of key HIV and health messages, UNAIDS Country Director for Bangladesh Leo Kenny said, "We are thankful to the WT20 partnership with ICC and UNICEF and its ambassadors like Shakib Al Hasan for using cricket as a vehicle for making HIV everybody's business.”

A new assessment report released by Victims 2 Survivors and UNAIDS is looking at the structural and institutional response to gender-based violence (GBV) in Namibia.

The report was disseminated during the commemoration of Orange Day, observed across the world on the 25th of every month, which takes its title from the official colour of the United Nations Secretary-General’s Unite to End Violence against Women campaign. 

Gender-based violence (GBV) in Namibia: an exploratory assessment and mapping of GBV response services in Windhoek analyses the challenges encountered by survivors while trying to access services. It also makes key recommendations, including strengthening multisectoral coordination mechanisms, developing relevant standards and protocols to guide service provision, integrating GBV prevention and survivor support into reproductive health and HIV programmes and establishing a free national GBV helpline.

Bience Gawanas, Special Adviser to the Minister of Health of Namibia, emphasized the need for a change in the gender norms of the country and an end to tolerance for GBV. “Let us make the invisible visible, and give a voice to the voiceless.”

According to WHO, one third of Namibian women have experienced or will experience intimate partner violence during their life. Nine out of ten victims of domestic violence are women and 33% of young women who were sexually active before the age of 15 report that their first experience was forced.

In his address to the nation on 21 February, the President of Namibia, Hifikepunye Pohamba, highlighted concrete measures to be taken by the government to reduce the alarming increase of violence against women. These included amending constitutional acts to tighten the requirements for bail and denying parole and giving longer prison sentences to perpetrators of GBV.

President Pohamba also declared 6 March as the national day of prayer for action against GBV in Namibia. “The lives of too many women and girls have been destroyed or disrupted,” said President Pohamba. “Gender-based violence, in all its manifestations, should not be tolerated in Namibia. Let us join hands, to make our country safer, for all, including our women and girls.”

During the Orange Day event, Father Richard Bauer emphasized the importance of involving faith communities in the fight against GBV. “Faith leaders can be crucial allies if they are empowered to intervene, prevent and heal. It’s an incredible amount of work, but can become a reality, if we all work together and acknowledge our mutual strengths,” he added.

A new UNESCO publication explores the evolution of HIV education and how it can be made more relevant to young people.

Charting the course of education and HIV examines what has been learned in the AIDS education journey, its opportunities and challenges. It then proposes a way forward in an area that is seen to be critical to the success of the overall AIDS response.

According to UNESCO Global Coordinator for HIV and AIDS Chris Castle, “HIV education can help learners to not only develop and maintain safer behaviours, but also reduce stigma and discrimination towards people affected by, and living with, HIV.”

Exploring the mechanisms and machinations of culture, values, beliefs and relationships of power has become more prominent and acknowledging that education and health are inextricably linked is now seen as vital. For example, HIV education can help to tackle some of the structural drivers of the epidemic, such as harmful gender norms, which can increase the vulnerability of women and girls.

According to the book, one of the major lessons learned in AIDS education has been the need to broaden the scope of HIV education and ensuring a more open and holistic approach to it. In that respect, largely gone are the early tendencies to teach HIV as a science topic concerned only with the biology of transmission, along with the scare tactics often used to discourage young people from becoming sexually active.

Instead, skills-based approaches have emerged that stress communication and coping strategies. Using interactive, student-centred methods of teaching, rather than heavily didactic ones, has been proven to be more successful.

Nowadays, many countries have adopted the newer paradigm. A survey carried out across 13 countries in the Caribbean in 2008 found that all of them provide skills-based health education. Equally, all 21 nations in east and southern Africa have a policy or strategy to promote life skills-based HIV education.

However, the book shows that there is still a long way to go on the ground. Many young people across the world still do not possess even basic knowledge about the virus. HIV education often remains marginalized. Numerous curricula are found to be deficient, with little reference to key aspects of sex and sexuality and a lack of information about where to access relevant services. Often, teachers do not feel confident about delving into topics they may find embarrassing and do not allow their students the space to explore these issues in a frank and open way.

Charting the course of education and HIV recognizes the need to reframe HIV education to respond to such deficits and rethink teacher training and support and integrate skills-based activities with school health programmes. HIV education will also have to be adaptive to the changes in the epidemic and encompass not only HIV prevention but treatment, care, support, and stigma and discrimination. There should also be redoubled efforts to meet the growing demands from young people, and increasingly their parents, for comprehensive sexuality education, joining with ministries, school heads and other teachers to develop a common agenda to help young people make informed choices about how to live healthy and fulfilled lives.

Samir, a shy 15-year-old, has come a long way. Living in Uzbekistan and diagnosed as HIV-positive around a year ago he thought at the time his life was over. He felt hopeless and depressed. Now, however, he is looking forward to a brighter future thanks to his involvement as a peer-to-peer trainer in an innovative project spearheaded by UNAIDS and UNICEF in Tashkent.

During the most recent project workshop Samir joined 22 other adolescents living with HIV in the Uzbek capital. They were there to learn more about how to provide peer-to-peer support for other adolescents living the same experience in their home regions. 

The trainees learned more about HIV prevention, care and support services as well as the increasing availability of HIV treatment options and the related improvement in quality of life. Learning how to challenge stigma and discrimination, which are still very prevalent in Uzbek society was also on the agenda. Many people living with HIV still fear being rejected and so keep their status secret.

For Samir the programme has made all the difference and he is now much more confident and optimistic. “I’m proud of having two hands, two legs and a head and I’m grateful to be alive. The most important things are family, health and a job that you like,” said Samir who wants to work in a bank in the future.

The peer-to-peer educator initiative started two years ago and UNAIDS and UNICEF have already trained 37 young people and intend to have ongoing training for new HIV-positive adolescents as well as reinforcing the capacity of those already trained. According to UNAIDS Country Director for Uzbekistan and Turkmenistan Lev Zohrabyan, the programme is playing a crucial role. “This initiative provides an opportunity for adolescents diagnosed with HIV to not only effectively cope with their own status but to also become leaders in guiding other peers in effective integration into society and living a fulfilled life”.

For Robert Fuderich, UNICEF Representative in Uzbekistan, the programme provides a safe haven where young people whose lives have been impacted by HIV “have access to psycho-social support, medical and legal counseling and most importantly, to an environment free of stigma and discrimination.”

Although HIV prevalence in Uzbekistan is relatively low, with an estimated 0.1% of the adult population living with the virus, the country is in a region which continues to have the largest increase in newly registered HIV cases in the world.