A Long Way to Zero… | World AIDS Day 2013

(Photo by Peter Caton for India HIV/AIDS Alliance)

(Photo by Peter Caton for India HIV/AIDS Alliance)

“Getting to zero” is the theme of this year’s World AIDS Day. It is an ambitious goal, to be sure. Three goals, in fact. Three zeros. Zero new HIV infections. Zero AIDS deaths. Zero stigma and discrimination. Are we now so close to declaring victory? Are we really on a path to an AIDS-free world? Is the end of AIDS on the horizon?

On one hand, we have never been better positioned to achieve such goals. We have good epidemiological data. We know where the epidemic thrives. We know who are most at risk, and we have the tools to reduce their vulnerability. For those infected, we have treatment.

Yet mastering this epidemic remains elusive. Why does there still seem to be zero chance that we will achieve any of UNAIDS’ zero targets anytime soon? Although it’s no longer popular to say so, AIDS remains exceptional. As a virus, it has proved remarkably resourceful, outwitting scientists and keeping a vaccine or cure out of reach.

But for all its microscopic muscularity, HIV is still winning because we’re letting it win. Those most at risk — sex workers, men who have sex with men, people who inject drugs, transgenders and hijras — remain on the margins, socially stigmatized and victimized by legal discrimination. People living with HIV bear a daily burden of society’s cruelty and inaction.

Don’t get me wrong. Things are better than they’ve ever been, but better isn’t good enough. Our tools and knowledge can only stifle this epidemic if they are marshaled to the task. Government coordination must be matched with community mobilization and sustained in collaboration with civil society. National treasuries, donor governments, corporate houses and private citizens alike need to pitch in to support these efforts.

This World AIDS Day, even as we appreciate progress in India and elsewhere, we should not lose our momentum or let crumble the foundation that has been built in the quarter century since the first World AIDS Day in 1988. The path to zero is still long, even if the destination is clear.

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The author of this blog, James Robertson, is Executive Director of India HIV/AIDS Alliance in New Delhi.

This blog was republished on One World South Asia on 2nd December 2013. 

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AIDS Response at Crossroads: World AIDS Day 2013

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This year’s World AIDS Day will not just be a string of events the world community observes every year on December 1st, reiterating our resolve to combat the pandemic. This year, it will occur at a defining moment in the global response when all stakeholders are standing at crossroads, looking to where we should head.

There is celebration, sometimes excessive, about the successes achieved since 2001 when the rules of engagement with HIV/AIDS changed from appeasement to aggressive combat, denial to ownership, and condemnation to meaningful participation by communities infected and affected by the epidemic. The resource base for AIDS programmes moved to billions, and affordable generic medicines have been made available, saving the lives of 10 million people. New infections have made an appreciable decline of 33% in the Ground Zero of the epidemic, sub-Saharan Africa. Most important, there has been an aggressive breakthrough in reducing the number of children born with HIV, and the target of zero new infections among children by 2015 appears feasible.

Encouraged by this impressive progress, world leaders have started talking about an AIDS-free society as an achievable goal in a finite time frame. Secretary-General United Nations has spoken on more than one occasion about the emergence of an AIDS-free world. The UN Joint Programme on AIDS (UNAIDS) has adopted the achievement of three zeroes as a global strategy. A new Commission established jointly by UNAIDS and Lancet has ‘what will it take to end AIDS’ as one of its three overarching objectives.

An outsider who is not familiar with the history of the epidemic can be led to believe that success is on hand and an AIDS-free world is just round the corner. This is the pitfall in crying victory too early when there are many challenges lying ahead, including sustainable financing and political support for AIDS programmes. While new infections are on decline in Africa and Asia-Pacific, they are still on rise in Eastern Europe, Middle East and Northern Africa. Another 5 million more people are in need of treatment, and this number will increase further with the new WHO guidelines on treatment. The biggest obstacle is however the adverse legal environment surrounding the people living with HIV and key affected populations. Progress on decriminalising these behaviours has been extremely slow and in some countries negative.

Resource availability for AIDS programmes has been impressive until now, but it is uncertain whether countries will commit matching domestic resources to cover the gap left by withdrawal of donors from AIDS financing. Evidence shows that external financing has funded prevention programmes focussing on vulnerable key populations. These communities are apprehensive about whether countries would continue with this prioritisation once the external funds are withdrawn. And for political leaders at country level, AIDS is no more a challenge. By providing treatment services to infected populations and preventing them from dying, they feel they have won the battle.

The added challenge on this World AIDS Day is the ongoing global dialogue on defining the post-2015 development agenda for the next 15 years. In the next year, world leaders will be actively negotiating various components of a new development regime where priority will be accorded to issues like environment and sustainable development. There is overall concern whether health and HIV will get the right priority in the post-2015 agenda. As this will evolve through an intergovernmental process in the UN General Assembly, much depends on what priority country leadership, especially non-health actors, will accord to AIDS and whether emergence of an AIDS-free society would be considered by them as an achievable goal.

On this World AIDS Day, we need to be vigilant and work closely with country leadership and UNAIDS to ensure that AIDS is not dropped just at a time when the battle is half won.

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The author of this post, J.V.R. Prasada Rao, is UN Secretary-General’s Special Envoy for AIDS in Asia and the Pacific and serves as chair on the board of India HIV/AIDS Alliance.

Renewing Our Commitment to the Global Response to HIV/AIDS

Image 1Globally, the incidence of new HIV infections and the number of AIDS-related deaths are decreasing. According to a recent report by UNAIDS, the annual number of deaths fell from 2.3 million in 2005 to 1.6 million last year. In 2001, there were more than half a million new HIV infections in children; in 2012, there were just over a quarter of a million.

Much of this progress is due to significantly expanded access to antiretroviral drugs particularly in low- and middle-income countries. Investment in antiretroviral drugs increased from $3.8 billion in 2002 to $18.9 billion last year. Significant results have also been achieved in reducing the number of deaths among those co-infected with TB and HIV, which have declined by 36% since 2004.

Despite flattening donor funding for HIV, which remains around 2008 levels, domestic spending on HIV has increased, accounting for 53% of global HIV resources in 2012. Nonetheless, the total global resources available for HIV in 2012 were estimated to be roughly US$ 3-5 billion short of the US$ 22-24 billion estimated to be needed annually by 2015.

The UNAIDS report also reviews progress on ten specific targets which were set by United Nations member states in the 2011 Political Declaration on HIV and AIDS. Progress has been slow in protecting human rights, securing access to HIV services for people most at risk of HIV infection, and in preventing violence against women and girls––all key factors in reducing vulnerability to HIV. Gender inequality, punitive laws and discriminatory actions continue to hamper national responses to HIV, and concerted efforts are needed to address these persistent obstacles to the scale up of HIV services for people most in need.

With support from donors like the Global Fund, PEPFAR, and the Bill & Melinda Gates Foundation, India HIV/AIDS Alliance in collaboration with hundreds of organisations across the country supports sustained and effective community-based responses to HIV. We focus our efforts on populations most affected by the epidemic, including men who have sex with men, transgenders, hijras, people who inject drugs and sex workers, as well as people living with HIV from all walks of life, including women and children.

Watch for our social media series, ‘The Six Strides’. Over the coming week, we will highlight the progress that we have made with our partners in six of the ten HIV/AIDS targets defined by the UN in the 2011 Political Declaration.

Women Out Loud: New UNAIDS/UNWomen Publication Cites Our Chanura Kol Project

UNAIDS and UN Women recently released Women Out Loud, a new report on women living with HIV and the key role that they play in ending the epidemic. A UNAIDS feature on the document’s release notes the following:

In a new report, entitled Women Out Loud, UNAIDS explores the impact of HIV on women and the instrumental role women living with the virus are playing to end AIDS. It includes the latest data and commentary from some of the leading advocates on women and HIV.

The report includes the voices of some 30 women living with HIV who have given their personal insights into how the epidemic is affecting women and on how women are actively working to reduce the spread and impact of AIDS.

HIV is continuing to have a disproportionate effect on the lives of women. It is still the leading cause of death for women of reproductive age, and gender inequalities and women’s rights violations are persistent in rendering women and girls more vulnerable to HIV and preventing them from accessing essential HIV services…

Marginalised women remain the most impacted by HIV

Sex workers and people who use drugs are particularly vulnerable to HIV. When sex is exchanged for money or drugs, women often exert little influence over a partner’s condom use. Female sex workers are 13.5 times more likely to be living with HIV than other women. Some countries reported an HIV prevalence of more than 20% among female sex workers in capital cities. Studies conducted in nine European Union countries have indicated on average a 50% higher prevalence of HIV among women who inject drugs than in men who inject drugs.

On page 21 of the report in the chapter on people who use drugs, the following point is made: “Women who use drugs are widely reported to experience disproportionate levels of stigma and discrimination, often compounded during pregnancy, and as mothers.” One of the three references for this observation is In the Shadows, the baseline findings report from our Chanura Kol project.

India HIV/AIDS Alliance is grateful to UNAIDS and UN Women for this citation of our work. Many thanks to the Chanura Kol team and particularly to our implementing partners, SASO and Shalom, for their many contributions to the report and to the project overall. To read more about our baseline findings, click here or on the report cover below.

In the Shadows: Chanura Kol Baseline Report_Alliance India 2011

Chanura Kol is funded by the Elton John AIDS Foundation and serves to expand interventions to decrease HIV transmission and reduce drug relapse among women who inject drugs. Based on a holistic and sustainable approach, the project was initiated in 2010 to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s northeastern state of Manipur, many of whom are also sex workers. Chanura Kol provides these women with long-term shelter, creates opportunities for income generation outside of sex work, and helps them rebuild family relationships.

Chanura Kol is one of a handful of efforts in the region to address the distinct needs of women who inject drugs and reduce their vulnerability to HIV. To learn more, please see a recent slide show about the project:

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Increasing Civil Society Involvement in the Fight Against HIV in China

Chinese delegates with Alliance India members in New Delhi

India HIV/AIDS Alliance recently hosted a study tour of the Pehchan project for the China Association of STD and AIDS Prevention and Control (AIDS Association). This tour came in the wake of a significant decision made by the Chinese Government a few years ago to support the increased involvement of civil society organisations (CSOs) in the response to AIDS in China.  To support this goal, the AIDS Association was selected by the Global Fund to handle its contribution of $18 million for Community Based Organisations (CBOs). The journey ahead for the AIDS Association is an exciting one especially given the scale of its responsibilities, which include establishing an independent grant management mechanism managed by civil society.

The visiting team, consisting of delegates from the AIDS Association, China CDC, Ministry of Health, Chengdu Gay Care Organisation (CGCO), State Council AIDS Working Committee Office (SCAWCO) and UNAIDS China, were given a complete overview of the National AIDS Control Programme in India. They met with various stakeholders in NACO, SACS, UNAIDS, and the Bill & Melinda Gates Foundation to understand the role of the government, UN agencies and big donors in promoting the participation of the CSOs in the national AIDS response. The delegates also visited a Hijra CBO in Hyderabad, supported by the Andhra Pradesh State AIDS Control Society (APSACS), which offered them the opportunity to interact with CSO members and hear their experiences about working with the government.

The team learned about Alliance India’s work, particularly the Pehchan programme, and received technical inputs on developing systems and mechanisms in the areas of M&E and finance. They also learned about the various systems which have been developed by Alliance India to provide technical support to CSOs and to build their capacities in the effective management of data and grants.

As the visit came to an end, the Chinese delegates shared a few insights gathered from their trip which resonated strongly with them. Amongst these was Pehchan’s ability to reach the hard-to-reach populations which the government would otherwise find difficult to make contact with. These interventions serve as a bridge to build the capacities of CBOs and to link communities to government supported HIV programmes. The delegates also stated that Pehchan’s ability to align the cost of the Global Fund programme with the Government’s unit costs is essential for the sustainability of the programme once the Global Fund’s support has ended.

You can learn more about the work being done on HIV and MSM by civil society organisations in China by clicking on Alliance China’s report, Community Response to HIV among Men who have sex with Men in China.

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With support from the Global FundPehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.