A poster about stigma in a HIV testing lab in Uganda. Credit: Lyndal Rowlands / IPS.

By Lyndal Rowlands
UNITED NATIONS, Dec 1 2016 (IPS)

Eighteen million people, just slightly under half of the people living with HIV and AIDS globally, are now taking life-saving medication, but global efforts to end the disease still largely depend on prevention.

While efforts to expand antiretroviral treatment have been relatively successfully, prevention efforts have been more mixed.

With the help of treatment, mother to baby transmission has dropped significantly. Transmission between adults aged 30 and over has also dropped.

However, transmission rates among adolescents have risen, causing concern, particularly about the high number of new cases among young women between the ages of 15 to 24.

According to UNAIDS, a new report published last week, “shows that the ages between 15 and 24 years are an incredibly dangerous time for young women.”

The report included data from six studies in Southern Africa, which showed that “southern Africa girls aged between 15 and 19 years accounted for 90% of all new HIV infections among 10 to 19-year-olds.”

“Young women are facing a triple threat,” said UNAIDS Executive Director, Michel Sidibé. “They are at high risk of HIV infection, have low rates of HIV testing, and have poor adherence to treatment. The world is failing young women and we urgently need to do more.”

The report also noted the countries that have increased their domestic funding for HIV prevention, “including Namibia, which has committed to investing 30% of its HIV budget in preventing HIV among adults and children.”

Ensuring the continued and renewed domestic and international funding for both treatment and prevention was the subject of discussion at the Center for Global Development in Washington D.C. on Monday.

The event, held ahead of World AIDS Day on 1 December, focused on a U.S. government initiative aimed at involving government finance departments, as well as health departments, in the HIV response.

Currently over 55 percent of the HIV response in low and middle-income countries comes from the governments of low and middle income countries.

However a significant amount of international support, roughly one third overall funding, comes from the U.S. government, which has made tackling HIV and AIDS a priority through the President’s Emergency Plan for AIDS Relief (PEPFAR).

However while U.S. funding for the HIV and AIDS response is considered bipartisan HIV and AIDS support, like any U.S. government program may change under Presidency of Donald Trump.

IPS spoke to Amanda Glassman, Vice President for Programs and Director of Global Health Policy at the Center for Global Development after the event:

“Of course we all hope that this is a bi-partisan consensus but the fact that we, the U.S. government, continue to pay directly for service delivery in some countries is a huge risk,” she said. “On the one hand I think maybe it makes it harder to cut, but on the other hand if it does get cut it’s a disaster.”

Of the 18 million people currently on antiretroviral treatment globally, “4.5 million are receiving direct support,” from the U.S. while an additional 3.2 million are receiving indirect support through partner countries.

While there remains broad consensus over treatment, prevention efforts are considered more politically contentious.

Previous Republican administrations have supported abstinence programs, which studies have shown to be ineffective at preventing HIV transmission.

Glassman noted that while there is more political consensus over treatment programs “you need prevention really to finish this.”

However she noted one positive example from incoming Vice-President Mike Pence’s home state of Indiana.

“(Pence) actually eliminated (needle exchange) programs and then saw HIV / AIDS go up and so he reversed his position, so I think that sounds good, he listens to evidence and action,” said Glassman.

However Pence’s record on women’s reproductive rights and his reported comments that in 2002 that condoms are too “modern” and “liberal”, may not bode well for overall prevention efforts, especially considering that addressing higher transmission rates among adolescent girls also requires addressing gender inequality and sexual violence. Update: In 2000, Pence’s campaign website also said that a US government HIV/AIDS program should direct resources “toward those institutions which provide assistance to those seeking to change their sexual behavior,” a statement many have interpreted as support for gay-conversion therapy.

Reducing the high rates of transmission among adolescent girls will not be easy. It involves increasing girls economic independence as well as helping them to stay in school longer.

“It’s a discussion of investment in secondary school … so the discussion is bigger than health,” said U.S. Global AIDS Coordinator, Deborah Birx at the event.

This is one of the reasons why involving government finance departments is important.

However finding additional funds for both education and health in the “hardest hit countries” will not be easy, said Glassman.

“(These countries) are coming in with growth projections that are much lower, they have pretty low tax yields meaning that the amount that they get from their tax base is pretty low.”

A Rainbow flag is displayed in the window of the United States Mission to the United Nations during LGBT Pride Month. Credit: Phillip Kaeding / IPS.

By Tharanga Yakupitiyage
UNITED NATIONS, Jun 13 2016 (IPS)

Though the High Level Meeting on Ending AIDS ended with the adoption of bold and life saving targets, many organisations have expressed their disappointment in its outcomes.

During the meeting, the international community adopted a new Political Declaration that lays down the groundwork to accelerate HIV prevention and treatment and end AIDS by 2030.

UN member states committed to achieving a 90-90-90 treatment target where 90 percent of people living with HIV know their status, 90 percent who know their HIV status are accessing treatment and 90 percent of people on treatment have suppressed viral loads. Reaching the treatment target will prevent 75 percent of new infections and ensure that 30 million people living with HIV (PLHIV) have access to antiretroviral therapy (ART) by 2020.

Though many organisations that IPS spoke to were encouraged by the commitments, they also expressed concern and disappointment in the Declaration’s shortfalls.

“I think what the high level meeting showed us was the gap between reality and politics at the UN,” said International Women’s Health Coalition’s (IWHC) Director of Advocacy & Policy, Shannon Kowalski.

“The Political Declaration didn’t go far enough to address the epidemic that we face today,” she continued.

Many were particularly concerned with stripped and exclusionary language on so-called key populations in the document.

“When we saw in the Declaration that key populations were less mentioned than 5 years ago…it is a real setback,” Alix Zuinghedau from Coalition Plus, a French international union for HIV/AIDS organisations, told IPS.

Among these key populations is the lesbian, gay, bisexual and transgender (LGBT) community. Though the LGBT population continues to be disproportionately affected by HIV/AIDS, they are only mentioned once in the Declaration.

Executive Director of Stop TB Partnership Lucica Ditiu told IPS that the document mentions vulnerable populations in relation to tuberculosis (TB), but that it should have been extended throughout the Declaration.

“We have a saying in my country: With one eye I laugh, with one eye I cry. Because that piece was missing,” she said.

The Declaration includes a target to reduce TB-related deaths among people living with HIV by 75 percent by 2020.

Amirah Sequeira, Associate Director of Health Global Access Project’s (GAP) International Campaigns and Communications, also noted the lack of language and commitment to decriminalize key populations including men who have sex with men, people who inject drugs and sex workers.

“The exclusion of commitments to decriminalize these populations will hold back the ability for the world to reach the bold new targets that the Declaration committed to,” she told IPS.

When asked about these concerns, the Deputy Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS), one of the main organisers of the meeting, Luiz Lorres told IPS that this exclusion will impede efforts to achieve the 90-90-90 treatment target.

“I acknowledge that more needs to be done,” he said.

Organisations have also pointed to issues around financing.

Through the Declaration, governments have committed to increasing funds for HIV response to $26 billion per year by 2020, as estimated by UNAIDS. However, Sequeira noted that not only is there a $6 billion funding gap, but also donors tend to flat line or reduce funding despite pledges.

“[Reaching the goal] will not be possible if donors continue to do what unfortunately they have been doing which is flat lining or pulling back funding from global AIDS programs,” she told IPS.

Though she applauded the U.S. President’s Emergency Plan for AIDS Relief’s (PEPFAR) newly launched $100 million Key Populations Investment Fund, Sequeira stated that PEPFAR needs a $500 million increase each year between now and 2020 in order for the U.S. to provide its fair share of needed financing.

Zuinghedau told IPS that without additional funding to scale up programs for key populations, the goal to reduce infections and end AIDS will not be possible.

“It is very frustrating to see countries say, yes we want to end AIDS but we’re not going to add any more funding. It’s a contradiction,” she told IPS.

The government of Canada recently announced a pledge of almost US$615 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria for the next three years, a 20 percent increase from its previous pledge.

Kowalski applauded the move, stating: “If Canada can do it, we know that other governments can do it as well.”

Though the Declaration highlights the need to increase domestic resources for countries’ own HIV response, Ditiu stressed the need to ensure that governments continue to invest in vulnerable groups because they are often the first ones to “fall between the cracks.”

She added that it is important to include key populations in the implementation of commitments.

Sequeira also urged for the implementation of strong accountability mechanisms to ensure that commitments are translated into effective responses.

Though the Political Declaration is not “perfect,” Kowalski noted that it provides the bare minimum required to take HIV response to the next level.

“If we are serious about ending AIDS, we need to go far beyond what is in the Political Declaration,” she said.

Loyce Maturu, a Zimbabwean living with AIDS since the age of 12 and an advocate for people living with HIV/AIDS, addresses the General Assembly High-level Meeting on HIV/AIDS. UN Photo/Rick Bajornas

By Aruna Dutt
UNITED NATIONS, Jun 10 2016 (IPS)

Young people are disproportionately affected by HIV, yet their concerns about sexual education, and discrimination of key populations were ignored at the UN General Assembly High Level Meeting on ending AIDS.

Although the overall number of AIDS-related deaths is down 35 percent since 2005, estimates suggest that AIDS-related deaths among adolescents are actually rising.

In fact, AIDS is a leading cause of deaths among adolescents in Africa, and it is the second greatest cause of death among adolescents globally.

Young people’s vulnerability to HIV is exacerbated by a lack of access to comprehensive sexual and reproductive health information and services and by exclusion from decision making processes.

At the UN General Assembly High Level Meeting on ending AIDS this week, Member States adopted a new political declatarion focusing on the Fast-Track approach to fighting HIV and ending AIDS by 2030. Fast-Track is driven by the 90–90–90 targets: that by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their status are receiving treatment and 90% of people on HIV treatment have a suppressed viral load so their immune system remains strong and the likelihood of their infection being passed on is greatly reduced.

But youth delegates say that issues of stigma, discrimination, and sexual education were not given the importance they should have in the declaration since youth were not included in the negotiations.

“The concept of 90-90-90 is amazing, but in practice without access to sexual education or participation of key populations and young people, the goals are unrealistic,” said Peter Mladenov, one youth representative from Youth Peer Educational Network.

At the High Level Meeting on Ending Aids, there were 20 young people representing different organisations.

“Unfortunately, all youth representatives were excluded from the negotiations on the high level meeting on Aids political declaration,” said Mladenov.

“Our wishes were not heard and the rights were not promoted since in the final document we did not see any sexuality education, or mentioning of key populations.”

Mladenov is an expert on youth policies and has been a youth advocate for Sexual and Reproductive Rights  and Comprehensive Sexual Education for the past 10 years. At the age of 14, he was invited to join a class on sexual education in school which he says changed his life and began his journey with sexual health and reproductive rights advocacy.

“Sexual education is the direct link between HIV / AIDS and sexual health and reproductive rights. The sooner we realize this, the sooner we will achieve an HIV free generation.”

“Sex ed is not only about the sex, it is about the informed choice of each young person, understanding the changes in your body, a young girl having the right to say no to marriage at age 15, an instrument to prevent child abuse or female genital mutilation.”

Mladenov says sexual education can help end stigma and discrimination.

“It is nice that we are progressing, same-sex marriage is approved in different countries and shows that the world is changing for the better. But there is still a long way to go, people with HIV still experience stigma and discrimination on a daily basis. When someone discriminates against a person it is usually because they are afraid of something, which is why sexual education is so important.”

Another youth leader attending the meeting was Annah Sango from the HIV Young Leaders Fund Board:

“Sexual rights really are human rights, because when it comes to talking about my body and my health and well being, it is not an issue of a statistic, but what I live each and every day,” said Sango.

“It is every young person’s need and right to be in your own country, and be able to know you have access to health and to know that the justice system is working for you, not against you.”

Sango grew up seeing how disadvantaged young people are, and how sometimes culture, society and tradition play a very crucial role in the lives of young people as much as the economic aspects. When asked what she would have wanted in the declaration, she said it was important to ensure that countries aren’t allowed to hide behind culture and religion, and rather have an open mind to the issues in their countries. She also said that member states should have given clear-cut strategies to address some of the pertinent issues facing young people.

Sango is also Advocacy Officer for the African Network of Young People living with HIV (AY+) which heavily advocates for Comprehensive Sexual Education and supports young people to dispel disinformation which drive stigma and discrimination.

“We cannot talk about AIDS whilst excluding young people and key populations. At country level, the agreement needs to reflect the face of HIV: young people that face violence, the millions of young people that have died because of their sexuality, the reality of teenage pregnancies, and of adolescents who are dying because they cannot be identified.”

Sango also said the negotiations for the declaration were very exclusive of youth voices, however she is optimistic that in the future youth will be included at the national level.

“I am confident that whatever goals, whatever agendas we are working towards, we will be able to achieve them if we include the right people to lead and champion the agenda,” said Sango.

Mladenov was also optimistic that about young people’s participation.

“Many people say that young people are the future, but that is not correct – we are the present, and we should be the ones who drive the sustainable development agenda to its accomplishment.” Mladenov told IPS.

“Although we don’t have what we want in the political declaration, we have the will, the power, and motivation to do it. The youth working on the local and national level should not be afraid to take up the floor, to go to their ministries, to demand that they involve youth as equal partners in implementing the declaration.”

“We should not forget that these people were elected by us, they are accountable to us, not vice-versa. If we have more governments really involving young people, we can achieve sustainable development.”

“Young people should be the agents of change, they should be the ones who push their governments to do something for them because they already agreed to with this declaration.”

“I dream for a day when I will not hear about a person coming from an LGBT community who is harassed, or a young woman or girl who is somehow violated, or a young person is excluded.”

IPS also spoke to Sharonann Lynch, HIV/Tuberculosis (TB) policy advisor at Medecins Sans Frontieres (MSF) Access Campaign.

“In many countries where MSF works, young people, especially adolescent girls and young women, are most at risk of contracting HIV,” said Lynch. “For example, in Lesotho, the prevalence of HIV will multiply by 5 in the next 7 years among adolescent girls from the age of 15 to 22. So the question for the region is what can we put in place as soon as possible to provide life-saving treatment as well as prevention.” Lynch told IPS.

“Youth are critical to combat stigma by creating more visibility. Young people can combat stigma by being out about their HIV status, demanding not only a voice but also acceptance in their communities. But governments need to make sure they take steps to reduce stigma and discrimination as well.”

Successive poor harvests have diminished Ndodana Makhalima’s household food stocks and the family’s nutrition status.

A subsistence farmer in Lupane, about 110 kilometres north of Zimbabwe’s second city, Bulawayo, 56 year-old Makhalima has learnt to live with hunger on his door step.

Farmers will have limited access to climate smart agricultural knowledge and skills as cash strapped Zimbabwe cuts technical assistance from agricultural extension officers. Credit: Busani Bafana/IPS

“In the past I could eat umxhanxa (a mix of maize and melon) and inkobe (a mix of maize, cow peas, and groundnuts) throughout the year, but not anymore,” Makhalima said.

“My silo is empty and my family has nothing to eat. I think today’s children will never know the kind of body-building foods we ate when I was young,” he said, highlighting the extent of compromised household
nutrition across rural Zimbabwe.

The country’s rural-based subsistence farmers are facing a myriad of challenges with the Famine Early Warning Systems Network (FEWSNET) warning of another drought during the 2015/16 season, which could further compromise already dire nutritional needs in a country where the UN World Food Programme (WFP) says millions will require food assistance.

But it is the financing of the sector, once a major contributor to the country’s GDP, that has further dwindled hopes for relief for Makhalima and millions of other rural farmers.

Zimbabwe requires millions of dollars to fund irrigation schemes dotted across the country and while the climate ministry and the meteorological services department announced a cloud seeding exercise in October to boost rainfall, this is yet to take off.

The meteorological office also announced it would be buying an aeroplane for cloud seeding, but the department has previously complained of financial constraints that have affected its operations. It is not clear where financing for the aircraft will come from. Experts however say cloud seeding can be done when there are particular clouds that favour the exercise.

Announcing the national budget on 26 Nov, Finance Minister Patrick Chinamasa said agriculture will require 1, 7 billion dollars, while setting aside 28 million dollars to fund farming inputs for 300,000 vulnerable rural households.

Under the scheme, small-holder farmers will receive maize and small grain seed and fertiliser.

But farmer unions say more will be required beyond these hand-outs as the country’s rain-fed agriculture faces
prolonged dry spells.
”The importance of this sector lies in its contribution to export earnings of around 30 per cent, 60-70 per cent of employment and about 19 per cent of GDP, that way providing a major source of livelihood for over 70 per cent [of the population],” Chinamasa told parliament in his budget presentation.

According to Chinamasa, agriculture production, which saw a plunge of 51 per cent from the 2013/14 season, will recover by 1.8 per cent despite the climate ministry’s warning that 2015/16 will be a
drought year.
The day after the budget presentation, Minister Chinamasa told a breakfast meeting that Zimbabwe would sign a 60-million dollar agreement with the UN International Fund for Agriculture Development (IFAD) to finance irrigation which the agriculture ministry is touting as a solution to boost agriculture production.

Yet subsistence farmers, who have relied on technical assistance from agriculture extension officers, could face tougher times ahead after the finance minister announced that these officers will face the chop as part of government efforts to reduce its wage bill.
These cuts come at a time when farmers seek new farming knowledge and skills to deal with climate vulnerability blamed for poor harvests.

The Zimbabwe Vulnerability Assessment Committee (ZimVAC), established by government and which sets benchmarks for rural nutrition with support from the UN World Food Programme, says 1.5 million people or 16 per cent of the country’s rural population, are food insecure. ZimVAC notes that this is a163 per cent increase from last year.

Development agencies have tied nutrition to people’s ability to lead productive lives with access to nutrition especially emphasised for vulnerable groups such as people living with HIV and Aids. WFP is already assisting malnourished HIV and Aids and tuberculosis patients around the country through the Health and Nutrition programme, with the potential to assist millions of patients living in rural areas according to the country’s health ministry.

There are, however, concerns that failed agriculture and poor harvests that have depleted household food stocks will make it difficult for HIV and Aids patients to access much needed nutritional support — a
vital requirement in anti-retroviral therapy.

During the October World Food Day commemorations led by the UN Food and Agriculture Organisation (FAO) and WFP, FAO Sub-Regional Coordinator for Southern Africa and Representative in Zimbabwe, Swaziland and Botswana, David Phiri, noted that the UN in Zimbabwe “recognises that in order to achieve inclusive agricultural development and food and nutrition security, targeted social protection programmes should be in place.”

As part of efforts to improve agriculture production and nutrition, FAO and WFP are assisting small-holders in adopting climate smart agriculture, complementing government efforts that emphasise rehabilitation of irrigation schemes across the country.

These interventions could offer much-need relief for farmers like Makhalima, for whom agriculture is vital for nutrition and income.

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