Agenda 1.3: Report of the Executive Director
Statement by Stop AIDS Alliance, Harm Reduction International, and the International HIV/AIDS Alliance
Over the past few years, the international community has agreed to and adopted a set of ambitious commitments to end AIDS. The UNAIDS Strategy specifically states that to end the AIDS epidemic among people who inject drugs, comprehensive packages of harm reduction services should be established. This can only be achieved if appropriate levels of political leadership and funding are shown by national governments, UN agencies, and donors.
It is estimated that out of 11.7 million people who inject drugs worldwide, 14% are living with HIV. Data released last month by Harm Reduction International shows that since 2014, no new countries have established needle and syringe programmes (NSP) and just 3 have introduced opioid substitution therapy (OST). Of 158 countries where injecting drug use is reported, over half (78) do not offer Opioid Substitution Therapy and more than a third (68) still do not provide Needle Syringe Programmes. Moreover, the 2011 UN target to halve HIV transmission among people who inject drugs by 2015 was missed by 80%.
Critically, harm reduction funding is in crisis in many parts of the world, and without concerted action will reduce further as donors exit middle-income countries. UNAIDS also faces unprecedented cuts, with each Co-Sponsor’s budget to be reduced further in 2017, which will impact on the UNAIDS working model. For instance, by the end of 2016 UNODC will lose all but one of its regional HIV advisors. UNODC’s work on prisons and on linkages between law enforcement, health, prisons and drug control agencies will be reduced to just half of the 26 high priority countries, and its work on alternatives to imprisonment including for women who use drugs will be discontinued. That way we can lose all the gains made so far on the global HIV response.
Keeping the same level of core UBRAF funds in 2017 as in 2016 to cosponsors is critical; and so a strong accountability systems and adequately resources to improve the joint program working model. To end AIDS among people who use drugs by 2030, we need a rapid increase in political leadership and funding from donors, national governments and the UN Joint Programme. The 90-90-90 might not be the ultimate goal: the 10% not covered is key to the epidemic in country and ending AIDS. The final goal is to leave no one behind.
Statement by Dima Sherembey, All-Ukrainian Network of People Living with HIV
I am here because I was lucky enough to survive. I can stay alive and come here because in the morning, I have taken my ARV.
But many people don’t have such opportunity. They still don’t have access to ARVS. Thus, we need to see people behind the reports, they are not just numbers.
The Ukrainian government is in very hard environment. There is war and economic crisis, yet it was able to fully support OST from the national budget, 90 % of ARVs, and TB and Hepatitis program.
We need to remember that when we talk about access we actually talk about people’s lives. The Ukrainian Network is fighting to remove all barriers between people and treatment, economic, political, technical, patents and IP. Because there is no excuse for barriers when we talk about saving lives.
Agenda 3: Updated gap analysis on pediatric HIV treatment
Statement by theElizabeth Glaser Pediatric AIDS Foundation
The Elizabeth Glaser Pediatric AIDS Foundation would like to thank UNAIDS for its comprehensive pediatric gap analysis that highlights actions needed to eliminate mother-to-child HIV transmission and ensure all children born with HIV remain AIDS-free.
The report comes at the end of a momentous year on pediatric HIV. We have seen multiple actors on multiple occasions join together to ask, “What more can we do for children living with HIV?” Their calls created momentum for ambitious pediatric treatment targets for 2018 and 2020 in both the HLM Political Declaration and the new Start Free, Stay Free, AIDS Free framework. They also built momentum around a new initiative to accelerate pediatric formulation development.
The Global Plan to end mother to child transmission proved that focused attention and targets can work for children, just as they have for wider populations of people living with HIV.
The accelerated targets for children – targets that are even faster than fast track – reflect the dire urgency of their situation. HIV progresses very rapidly in children, with the highest mortality between 1 and 3 months. Yet only 50% of this age group is tested, only half of those receive results, and even less are linked to treatment. Scaling up early infant diagnosis – and ensuring quick test results and treatment initiation – is thus a matter of life and death for this most vulnerable group. But we can’t stop there. Repeat testing of HIV-exposed infants, particularly at the end of breastfeeding, must also receive more attention. Innovative approaches to tracking mother-infant pairs over time would help close these gaps.
And we can’t stop with infants either. The median age of initiation on treatment is 3.5 years, when 70% of untreated children will have already died. That’s simply unacceptable. We must work harder to find undiagnosed children of all ages, and find them earlier using better techniques and looking in higher yielding sites.
And though the targets measure treatment, adherence and retention are equally important, with drug resistance and loss to follow up particularly problematic for children and adolescents. Hastening the availability of optimal drugs, improving adherence support, and increased viral load testing are key, as is differentiated care across different age groups. We tend to forget that between 18 months and 18 years are a large number of HIV positive children with their own diverse set of issues and service requirements.
Finally, reaching treatment targets will require more systematic monitoring of the impact of stigma and discrimination on children and adolescents and more targeted efforts to combat them.
In conclusion, we support the decision points presented in the report, with their emphasis on both national ownership of the pediatric targets and continued Joint Program support in reaching them.
Statement by the World Council of Churches Ecumenical Advocacy Alliance
The World Council of Churches-Ecumenical Advocacy Alliance, welcomes this important discussion on paediatric HIV treatment, care and support because it highlights one of the most significant gaps in the HIV response as well as the very ambitious global target, agreed at the high level meeting, to double the number of children on treatment by 2018.
A key aspect of addressing the paediatric gap will require giving greater attention to strengthening community engagement, including the faith community. Communities are often best situated to define and respond to the evolving needs of children throughout their lives. In many countries faith –based organisations have much experience of providing, economic and social support through both service delivery and outreach programmes. A key element of the Start Free, Stay Free, AIDS Free initiative must be to ensure that community structures have sufficient human and financial resources and that linkages to facilities are strengthened.
As with adults, HIV-related stigma and discrimination are widespread against children and adolescents living with HIV and their parents. It can cause severe mental distress which prevents them from learning about their HIV status, adhering to treatment and from attending school and accessing other services. The WCC-Ecumenical Advocacy Alliance welcomes the commitment in the Political Declaration for the creation of safe and non-discriminatory learning environments, but calls on governments to work with all key stakeholders to ensure that this is achieved also in health facilities as well as more broadly in society as a whole. In addition, we call on UNAIDS to work with partners, including FBOs, to undertake additional research on the effects of stigma and discrimination on children and adolescents living with and affected by HIV and AIDS.
To ensure that the Start Free, Stay Free, AIDS Free Initiative is successful in doubling the number of children living with HIV on treatment by 2018, it will need to have a strong accountability framework. This will increase the likelihood that the needs of children affected by HIV will not be forgotten even if children themselves don’t have a voice in fora such as this.
Statement by GNP Plus
Thank you for this important, comprehensive report. Echoing the esteemed North American NGO Delegation member, words matter. Language is important – it can be used to devalue and disrespect people or empower and strengthen them. Language not only defines how people see us but ultimately how we see ourselves.
We know that HIV transmission can occur before, during or after birth. We also know that HIV is the only infection in which the person it came from is identified, and therefore blamed, rather than the emphasis being placed on the political, economic, social or structural factors that exacerbate our vulnerability to HIV. The term ‘Mother to child transmission’ places the onus for spreading the disease on the pregnant woman and all women, ignoring the fact that the woman is only the last link in a broken chain.
Stigma towards HIV+ pregnant women and mothers is a salient feature of their lived experience; and language contributes significantly to this. Stigma surrounding the terminology ‘mother to child transmission’ may prevent women from coming forward for testing, it may discourage disclosure of a woman’s status and it has also been shown to contribute to the promulgation of criminal laws for HIV+ women who are alleged to be harming their fetus/child. It also increases their vulnerability to gender based violence as well as coercive or forced sterilization.
HIV+ pregnant women and mothers deserve better. It is time for the joint programme to be BOLD and to actively change the language and framing around the term ‘Mother to Child transmission’. After over 10 years of requests from civil society on this issue, we are steadfast in our strong opposition to this disempowering, stigmatizing language. It is time for us to move forward, show leadership and advance the politically sensitive term ‘Vertical transmission’ in our official UNAIDS communications and publications.
A meaningful commitment towards stemming the epidemic and securing the wellbeing of pregnant women and HIV+ mothers living with HIV cannot be met without accelerating investment into integrated HIV treatment, prevention, SRHR and family planning care and support services coupled with the official adoption and promotion of a rights based inclusive, anti-stigmatizing term of Vertical Transmission from the UNAIDS joint programme as well.