First announced during the 2003 State of the Union Address by the then President, George W. Bush, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) is celebrating its 15th anniversary in 2018. Over the past 15 years, PEPFAR has dramatically changed the landscape of the global response to HIV, and bipartisan support across successive administrations since its launch has continued to ensure that PEPFAR expands it work towards controlling the AIDS epidemic.

Launched with an initial budget of US$ 15 billion over its first five years, PEPFAR has gone on to commit US$ 70 billion to the AIDS response. The funding has had remarkable results: in 2017, PEPFAR was supporting 13.3 million of the 21.7 million people living with HIV on treatment, including 1 million children, and in May 2018 announced that more than 14 million were on treatment.

PEPFAR has funded major HIV prevention programmes. The preventative effect of voluntary medical male circumcision on HIV transmission has been ramped up by funding more than 15.2 million circumcisions since 2003. Prevention of mother-to-child transmission of HIV services have ensured that 2.2 million babies have been born HIV-free, while 85.5 million people have accessed HIV testing services, allowing the people taking the tests to start on treatment or access HIV prevention services to stay HIV-free.

PEPFAR’s work with children orphaned or otherwise made vulnerable by HIV resulted in more than 6.4 million children being supported by PEPFAR in 2017, while the PEPFAR DREAMS programme saw new HIV infections among adolescent girls and young women drop by 25–40% in those locations in which the programme was implemented.

On 27 September PEPFAR published its 2018 progress report, showing the progress made one year into its 2017–2020 strategy. PEPFAR supports the AIDS response in 53 countries—of those, 13 are already on track to control their HIV epidemics by 2020, while many more could still do so through scaling up resources and policies to ensure access to HIV prevention and treatment services.

“The contributions of PEPFAR have transformed the lives of people living with or affected by HIV around the world,” said Michel Sidibé, Executive Director of UNAIDS. “We are very proud of our longstanding partnership and look forward to continuing to work closely together to deliver results for men, women and children, particularly the most marginalized.”

Faith-based organizations have long played a critical role in the response to tuberculosis (TB). Many faith-based health service providers have implemented effective TB/HIV responses modelled on decades of work on TB. Today, faith-based organizations are delivering effective, high-quality TB/HIV services that complement national public health programmes in the countries most affected by TB and HIV.

Successful TB/HIV responses address both the biomedical and the social determinants that underpin these illnesses, such as poverty, inequality, situations of conflict and crisis, compromised human rights and criminalization. Children and adolescents are particularly vulnerable to infection and the impact of TB/HIV on their families. Because they have positions of trust at the heart of communities, faith-based organizations can provide services and support that extend beyond the reach of many public sector health systems.

To provide an opportunity to strengthen relationships and forge new partnerships, on 27 September the World Council of Churches–Ecumenical Advocacy Alliance, in collaboration with UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Interagency Task Force on Religion and Development, hosted an interfaith prayer breakfast on the sidelines of the 73rd Session of the United Nations General Assembly in New York, United States of America. Keynote speakers and table discussions focused on the outcomes of the United Nations High-Level Meeting on Tuberculosis, which took place on 26 September, and examined how the longstanding experience of faith-based organizations in responding to TB/HIV can support the new declarations agreed by Member States during the historic high-level meeting.

The participants included faith leaders and health service providers from different religious traditions. Survivors of multidrug-resistant TB brought a powerful sense of urgency and reality to the discussion. The participants renewed their call to national governments to not only maintain, but increase, support in order to end AIDS and TB as public health threats by 2030.

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Cervical cancer—an illness that can be prevented by vaccination against the human papillomavirus (HPV) and that is curable if detected and treated early—is developed by more than 500 000 women each year, half of whom die of the disease. If cervical cancer prevention, screening and treatment efforts are not urgently scaled up, it is projected that this number could double by 2035.

Cervical cancer is an AIDS-defining illness, since women living with HIV who become infected with HPV are more likely to develop pre-invasive lesions that can, if left untreated, quickly progress to invasive cancer—women living with HIV are four to five times more likely to develop invasive cervical cancer. HPV infection has been found to significantly increase the risk of HIV transmission for both men and women.

Thanks to HIV treatment, many more women living with HIV are living long and healthy lives, but it is imperative that women living with HIV do not succumb to other illnesses, including cervical cancer. “It makes no sense to save a woman’s life from AIDS, only to let her die from treatable or preventable cancer,” President George W. Bush, whose George W. Bush Institute is leading efforts to end AIDS and cervical cancer, said in October 2015.

Nine out of 10 women who die from cervical cancer live in low- and middle-income countries. Given that the burden of HIV is primarily felt in low- and middle-income countries, and particularly by adolescent girls and young women, responding to both cervical cancer and HIV together in those countries is vital. Unfortunately, however, most low- and middle-income countries with a high prevalence of HIV have limited programmes for cervical cancer prevention and control.

There is a growing awareness of the need to maximize synergies between the AIDS response and efforts to prevent, diagnose and treat cervical cancer through HPV vaccination, education, screening and treatment. Likewise, existing HIV programmes can play a strategic role in expanding cervical cancer prevention services.

Reducing deaths from cervical cancer requires a wide-ranging approach that includes the following:

• Health education, including age-appropriate comprehensive sexuality education.
• HPV vaccination for adolescent girls.
• Screening all women at risk of developing cervical cancer. Screening programmes should include HIV counselling, testing and treatment, as well as other sexual and reproductive health services and treatment of precancerous cervical lesions and invasive and advanced cervical cancer.
• Ensuring access to palliative care, when needed.

“All women living with HIV need access to information on HPV and should be offered cervical cancer screening and treatment if necessary,” said Michel Sidibé, Executive Director of UNAIDS.

In May 2018, the United States President’s Emergency Plan for AIDS Relief, the George W. Bush Institute and UNAIDS launched a joint effort through a US$ 30 million partnership to accelerate efforts in eight sub-Saharan African countries to ensure that women and girls living with HIV are a priority in national cervical cancer prevention and control programmes.

“Thanks to the generosity of the American people, the United States President’s Emergency Plan for AIDS Relief has saved the lives of millions of HIV-positive women around the world,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, at the launch of the partnership in May 2018. “We must ensure these same women—mothers, daughters, aunts and grandmothers—who are living with HIV and thriving do not succumb to cervical cancer.”

As part of the United Nations Secretary-General’s strategy to prevent and respond to sexual exploitation and abuse, global leaders have come together to issue a statement reaffirming their personal commitment to eliminate sexual exploitation and abuse across the United Nations system.

In the statement, the leaders recognize the unique responsibility of the United Nations to set the standard for preventing, responding to and eradicating sexual exploitation and abuse within the United Nations system, address its impact effectively and humanely and safeguard and empower survivors.

The leaders are 48 heads of state or government from the Secretary-General’s Circle of Leadership and 22 United Nations entities, including UNAIDS. UNAIDS is firmly committed to zero tolerance for sexual exploitation and abuse anywhere and recently hosted a high-level event with the African Union during the 73rd session of the United Nations General Assembly to tackle sexual and gender-based violence in humanitarian crises.

In the statement, the leaders recognize the shared responsibility of the United Nations and its Member States to protect survivors and whistle-blowers and take appropriate action against perpetrators. They also express their commitment to working together to implement the United Nations Secretary-General’s strategy, which outlines four main areas of action: putting victims first; ending impunity; engaging civil society and external partners; and improving strategic communications for education and transparency.

Click here to read the full statement.

There are still alarming levels of violence against transgender people, and a lack of recognition of their rights. During a visit to UNAIDS headquarters in Geneva, Switzerland, on 18 September, Marcela Romero and Venus Tejada, representatives of the Latin American and Caribbean Network of Transgender People (REDLACTRANS), shared the startling fact that transgender women in the region have a life expectancy of only 35 years.

During the visit, Ms Romero and Ms Tejada met with the UNAIDS Executive Director, Michel Sidibé, and spoke about REDLACTRANS’ work in 13 countries. A grant to REDLACTRANS from the Global Fund to Fight AIDS, Tuberculosis and Malaria helped to establish a centre that collects testimonies and follows up cases of human rights violations committed against transgender women in Latin America and the Caribbean.

“Stigma, discrimination and violence against sexual and gender minorities prevent them from accessing health services,” said Mr Sidibé. “Everyone has the right to health, no matter their gender or sexual orientation. For that, we need zero discrimination for everyone, everywhere.”

Ms Romero and Ms Tejada also presented Mr Sidibé with a copy of REDLACTRANS’ report, Waiting to die, which compiles cases of human rights violations against transgender people and gives recommendations to decision-makers.

“Stigma and discrimination is a barrier to the services we need to stay healthy. Some transgender women are dying due to lack of access to treatment. Without comprehensive health care, there are no equal rights nor true democracy,” said Ms Romero

Since its creation in 2006, REDLACTRANS has promoted the development of gender identity laws. In Argentina, the Plurinational State of Bolivia, three federal districts of Mexico and Uruguay, where gender identity laws have been enacted, transgender rights are increasingly enforced and, consequently, transgender people can access health-care services. Such laws have brought about positive changes in the services provided to transgender people and resulted in less stigma and discrimination in health-care settings. “Without identification, one cannot travel, register for school or access many services that are essential to function in society,” said Ms Tejada.

Ms Romero and Ms Tejada called on UNAIDS to address how forced migration, persistent inequalities and poverty affect the quality of life of transgender women.

Of the 1.8 million children aged 0–14 years living with HIV globally, 1.7 million are in Africa. As part of efforts to eliminate mother-to-child transmission of HIV in Africa, the African Union and the Organisation of African First Ladies against HIV/AIDS (OAFLA), with support from UNAIDS, and partners launched a campaign called Free To Shine in early 2018.

Now the campaign is ready to be rolled out across 42 African countries but urgently needs funding. To enable the roll-out, the African Union and OAFLA held an event on the margins of the 73rd session of the United Nations General Assembly to help raise much-needed resources to support the campaign.

The roll-out of the campaign will allow OAFLA members to engage in community-level activities to help reduce stigma and discrimination at home and in the community, raise community awareness about the importance of adherence to treatment and retention in care for pregnant women and women who are breastfeeding and to promote male involvement.

As part of the campaign, the first ladies will also leverage their unique position to influence policy-makers and agenda-setters to better address the needs of women living with HIV—advocating for policies and laws that discourage stigma and discrimination based on HIV status and for the removal of user fees for pregnant women and women who are breastfeeding, as well as other barriers that limit access to HIV and health services.

The session was moderated by television and radio journalist Zeinab Badawi. 

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The World Health Organization recently released its Global tuberculosis report 2018. Although it shows encouraging pockets of progress in responding to tuberculosis (TB) and HIV in some areas, it paints a rather bleak picture on ending the dual epidemics by 2030.

HIV is a relatively recent epidemic, having first been identified in the early 1980s; however, TB has been around for thousands of years. Archaeologists believe that TB affected the ancient Egyptians, with King Tutankhamun himself having possibly been affected.

Many famous people have fallen ill or died of TB over the years, including John Keats, Frédéric Chopin, Charlotte and Emily Brontë, Nelson Mandela and Franz Kafka, to name but a few. In the early twentieth century, supposed cures for TB included day-long bracing outdoor siestas in Swiss mountain sanitoriums, freezing cold showers and diets of up to 12 meals a day washed down with litres of milk and wine, and even staying in cowsheds, where the warmth and ammonia gases given off by the animals’ urine was supposedly a balm for infected lungs.

Effective medicinal treatment for TB became available in the mid-1940s and has changed little since. Today’s medicine, although toxic and antiquated, is incredibly effective and relatively cheap. However, finding people with TB to treat and ensuring that they stay on treatment poses problems and is particularly urgent for people living with HIV.

The World Health Organization estimates that in 2017 there were around 10 million people with active TB disease, 9% of whom were people living with HIV. Of the 10 million, approximately 3.6 million, or 36%, are “missing”, meaning that they may not have been diagnosed or properly treated. Among people living with HIV, the gap is wider, at 49%.

People living with HIV with latent TB are around 20 times more likely to develop active TB. Untreated TB is rapidly fatal among people living with HIV.

Fewer than 60% of TB patients are screened for TB, precluding treatment and resulting in preventable deaths. TB is the leading infectious killer globally and the leading killer of people living with HIV, accounting for one in every three AIDS-related deaths. In 2017, around 1.6 million people died of TB, including 300 000 people living with HIV.

Many breakthroughs can be achieved by improving collaboration between HIV and TB programmes to find and treat TB and HIV, including investing in diagnostics, vaccines and medicines, including preventive medicine and medicine to treat TB, including multidrug-resistant TB.

However, more commitment, investment and action are needed.

It is estimated that US$ 10.4 billion is required in 2018 for an effective response to TB in the 118 low- and middle-income countries that account for 97% of reported cases globally. The actual amount available in 2018 was US$ 6.9 billion—a shortfall of US$ 3.5 billion.

To respond effectively to HIV, UNAIDS estimates that US$ 26.2 billion will be required for the AIDS response in 2020. In 2017, US$ 21.3 billion was available in low- and middle-income countries—a shortfall of around US$ 5 billion. Only by filling the funding gaps will ending the epidemics start to become a reality.

With around 1.7 billion people, or 23% of the world’s population, infected with latent TB, of whom 5–10% have a chance of developing active TB disease, the world needs to take urgent action.

On 26 September, world leaders will come together at the United Nations in New York, United States of America, for the very first United Nations High-Level Meeting on Tuberculosis. As TB takes centre stage for one important day, the world has the opportunity to set some bold actionable targets to end two of the world’s leading infectious killers: TB and HIV.

To seize this opportunity would not only stop more than 6000 people dying every day from TB and HIV, but it would prevent new infections and bring the world a giant leap closer to improving global health, reducing poverty and achieving the Sustainable Development Goals.

Noncommunicable diseases (NCDs) are by far the biggest killers of people worldwide, responsible for 71% of all deaths globally. Defined by the World Health Organization as diseases of long duration and generally slow progression, the four main types of NCDs, which account for 80% of all NDC premature deaths, are cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.

People of all ages can be affected by NCDs, but they tend to affect older people. With increasing numbers of people living with HIV accessing treatment and hence living longer, people living with HIV are increasingly falling ill with NCDs. Being HIV-positive, however, also increases the risk of developing NCDs, either because of the infection itself or owing to side-effects of the medicines used to treat HIV. The care that people living with HIV receive therefore increasingly needs to include care for NCDs.

Since people in many low- and middle-income countries are smoking more, drinking alcohol more and becoming less active, and their diets are changing, rates of NCDs are increasing. Age-adjusted death rates from NCDs are nearly twice as high in low- and middle-income countries as in high-income countries.

However, the successes to date in the AIDS response show what can be done if countries take decisive action. It is becoming increasingly clear that if the world is to control NCDs, the lessons of the AIDS response need to be learned and applied to the response to NCDs.

Health-care systems in regions that are home to most people living with HIV were designed to primarily address acute, rather than chronic, illnesses. However, HIV programmes in those same countries can be good models for how to step up services for NCDs, showing how to provide continuity of care, support adherence to treatment and engage communities.

The AIDS response has had a huge impact on global health. The impact of early diagnosis and treatment, HIV services being in many countries the entry point for broader health services, the importance of tackling poverty and other social determinants of health, raising community awareness and creating demand for services, the importance of putting civil society and communities in the centre, with their engagement, activism, advocacy and mobilization—these are all key lessons from the AIDS response that can guide the response to NCDs.

“The response to HIV has shown that the impossible is possible,” said Michel Sidibé, the Executive Director of UNAIDS. “UNAIDS will work with our partners in the United Nations system to share best practices from the AIDS response to guide countries, communities and other partners.”

As part of the world’s effort to combat NCDs, on 27 September countries will come together in New York, United States of America, at the United Nations for the Third High-Level Meeting on the Prevention and Control of Noncommunicable Diseases. UNAIDS is a part of the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases and will be sharing its knowledge at the high-level meeting.

The health of women, children and adolescents is the cornerstone of public health. Healthy women and children create healthy societies and if adolescents are helped to realize their rights to health, well-being and education they become equipped to attain their full potential as adults. However, each year approximately 5.9 million children die before the age of five years and 289 000 women die in pregnancy and childbirth.

As part of the United Nations response to this crisis, the former United Nations Secretary-General, Ban Ki-moon, launched an initiative during the 2010 United Nations Millennium Development Goals summit to save and improve the lives of millions of women, children and adolescents around the world.

The initiative, Every Woman Every Child, was an unprecedented global movement that mobilized action by governments, the private sector, academia and civil society to address the major health challenges facing women, children and adolescents. As part of its work, the movement put into action a Global Strategy for Women’s and Children’s Health, a road map to galvanize political leadership and resources and to create a powerful multistakeholder movement for health.

The technical work of the movement is done by the H6 partnership, currently chaired by UNAIDS, which puts to work the collective strengths of UNAIDS, the United Nations Population Fund, the United Nations Children’s Fund, UN Women, the World Health Organization and the World Bank Group to operationalize the Global Strategy for Women’s and Children’s Health.

Today, spearheaded by the current United Nations Secretary-General, António Guterres, Every Woman Every Child is a multistakeholder platform that is saving millions of lives by placing women, children and adolescents at the centre of universal health coverage and the Sustainable Development Goals.

To highlight the need for continued political momentum around the movement, Every Woman Every Child held a high-level reception during the 73rd Session of the United Nations General Assembly in New York, United States of America, to underscore the importance of commitment, action and accountability by high-profile global leaders and influencers.

At the 2010 launch, more than US$ 40 billion was pledged, with numerous partners making additional financial, policy and service delivery commitments. However, speakers at the event highlighted that more help is urgently needed.

They stressed that the international community must pledge additional commitments to take Every Woman Every Child past the tipping point, which, the organizers say, would save the lives of 16 million women and children, prevent 33 million unwanted pregnancies, end stunting in 88 million children and protect 120 million children from pneumonia.

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We must protect, promote and fulfil human rights if we are to achieve HIV and health targets on the African continent and ensure access to HIV prevention, treatment, care and support services for all. This was the main call to action during a recent regional consultation for national human rights institutions and parliamentarians held in Nairobi, Kenya.

“This conference is indeed very timely for Africa, as it offers an opportunity to deliberate on how best national human rights institutions can work with parliaments in fostering the right to health through building strong partnerships,” said Enid Muthoni, the International Development Law Organization’s Country Director in Kenya.

National human rights institutions play a key role in promoting and protecting HIV-related human rights, including the right to health, and in ensuring that these are effectively addressed at the local and national levels. They serve as an important bridge between government, civil society and other stakeholders, helping to empower duty-bearers to respond to issues related to the right to health and rights-holders to realize these rights.

“Human rights and health are inherent for everyone. National human rights institutions, parliament and civil society and everyone at an individual level has a role to play in promoting the right to health,” said Madeleine Nirere, Chair of the Network of African National Human Rights Institutions.

The right to health is especially important to promote among people being left behind by the AIDS response, including key populations—such as gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs—to claim their rights to non-discrimination, HIV prevention and treatment services, information and education and freedom from sexual coercion and violence.

“If you have no health, you have nothing else. Everyone should therefore have a right to health,” said Miriam Were, former Chairperson of Kenya’s National AIDS Control Council and Champion for an AIDS-Free Generation.

The call to action from the consultation focused on a broad-reaching range of human rights issues, including promoting public–private partnerships and policies and actions to end stigma and discrimination in health-care settings and other institutional settings, such as schools and workplaces. The participants also called for the repeal of punitive laws, policies and practices that create barriers to access HIV and health services and appealed to countries to ratify and domesticate the many existing African human rights mechanisms.

“The call to action will enable national human rights institutions and parliamentarians to firmly express their determination to help achieve the health and HIV targets and operationalize the resolutions and mechanisms at our disposal,” said Jantine Jacobi, UNAIDS Country Director in Kenya.