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Africa: HIV/AIDS 2009 Update

AfricaFocus Bulletin
Dec 6, 2009 (091206)
(Reposted from sources cited below)

Editor's Note

"Through its partnerships with more than 30 countries through September 2009, PEPFAR has provided direct support for life-saving antiretroviral treatment for over 2.4 million men, women and children. The Global Fund has supported treatment for 2.5 million people worldwide. Approximately 1.3 million people receive treatment supported by both PEPFAR bilateral programs and the Global Fund, and thus are counted in the totals for each organization. These numbers reflect the strong country-level partnership between PEPFAR and the Global Fund." - Joint press release by the Global Fund and PEPFAR, December 1, 2009

This AfricaFocus Bulletin contains several updates, a summary report on the new UNAIDS annual report, a joint press release by PEFPAR and the Global Fund, and the AIDS day speech by South African President Jacob Zuma.

Two other AfricaFocus Bulletins posted today contain commentary on U.S. AIDS policy, both from critics of funding "flatlining" by the Obama administration and in a press conference by Dr. Eric Goosby, the Global AIDS Coordinator for the U.S. Government.

USA/Africa: AIDS - No We Can't? (e-mail and web)

USA/Africa: AIDS - Yes, We Can? (web-only)

For previous AfricaFocus Bulletins on AIDS and other health issues, visit

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

"Eight-year Trend Shows New HIV Infections down by 17% - Most Progress Seen in Sub-Saharan Africa"

"Efforts Towards Universal Access to Hiv Prevention, Treatment, Care and Support Are Bringing Aids out of Isolation"

The 2009 AIDS Epidemic Update report released by UNAIDS, is available online at:

This story on-line at:

Geneva / Shanghai, 24 November 2009 - According to new data in the 2009 AIDS epidemic update, new HIV infections have been reduced by 17% over the past eight years. Since 2001, when the United Nations Declaration of Commitment on HIV/AIDS was signed, the number of new infections in sub-Saharan Africa is approximately 15% lower, which is about 400,000 fewer infections in 2008. In East Asia new HIV infections declined by nearly 25% and in South and South East Asia by 10% in the same time period. In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the epidemic has leveled off considerably. However, in some countries there are signs that new HIV infections are rising again.

The report, released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), highlights that beyond the peak and natural course of the epidemic—HIV prevention programmes are making a difference.

"The good news is that we have evidence that the declines we are seeing are due, at least in part, to HIV prevention," said Michel Sidibe, Executive Director of UNAIDS. "However, the findings also show that prevention programming is often off the mark and that if we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved."

In this first double issue, the UNAIDS Outlook report further explores how "modes of transmission" studies are changing the approach of HIV prevention efforts. The new magazine-style report looks at new ideas and ways to use the data collected in the companion epidemiological report.

An estimated:

  • 33.4 million [31.1 million - 35.8 million] people are living with HIV worldwide
  • 2.7 million [2.4 million - 3.0 million] people were newly infected in 2008
  • 2 million [1.7 - 2.4 million] people died of AIDS related illness in 2008

Universal access to HIV prevention, treatment, care and support

Data from the AIDS Epidemic Update also show that at 33.4 million, [31.1 million - 35.8 million] there are more people living with HIV than ever before as people are living longer due to the beneficial effects of antiretroviral therapy and population growth. However the number of AIDS-related deaths has declined by over 10% over the past five years as more people gained to access to the life saving treatment. UNAIDS and WHO estimate that since the availability of effective treatment in 1996, some 2.9 million lives have been saved.

"International and national investment in HIV treatment scale-up have yielded concrete and measurable results," said Dr Margaret Chan, Director General of WHO. "We cannot let this momentum wane. Now is the time to redouble our efforts, and save many more lives."

Antiretroviral therapy has also made a significant impact in preventing new infections in children as more HIV- positive mothers gain access to treatment preventing them from transmitting the virus to their children. Around 200,000 new infections among children have been prevented since 2001.

In Botswana, where treatment coverage is 80%, AIDS-related deaths have fallen by over 50% over the past five years and the number of children newly orphaned is also coming down as parents are living longer.

AIDS out of isolation

One of the significant findings of the report is that the impact of the AIDS response is high where HIV prevention and treatment programmes have been integrated with other health and social welfare services. Early evidence shows that HIV may be a significant factor in maternal mortality. Research models using South African data estimate that about 50,000 maternal deaths were associated with HIV in 2008.

"AIDS isolation must end," said Mr Sidibe. "Already research models are showing that HIV may have a significant impact on maternal mortality. Half of all maternal deaths in Botswana and South Africa are due to HIV. This tells us that we must work for a unified health approach bringing maternal and child health and HIV programmes as well as tuberculosis programmes together to work to achieve their common goal."

The AIDS epidemic is evolving and HIV prevention programmes are not rapidly adjusting to the changes

The double report also shows that the face of the epidemic is changing and that prevention efforts are not keeping pace with this shift. For example the epidemic in Eastern Europe and Central Asia once characterized by injecting drug use is now spreading to the sexual partners of people who inject drugs. Similarly in parts of Asia an epidemic once characterized by transmission through sex work and injecting drug use is now increasingly affecting heterosexual couples.

Data show that few HIV prevention programmes exist for people over 25, married couples or people in stable relationships, widowers and divorcees. These are the same groups in which HIV prevalence has been found to be high in many sub-Saharan countries. For example in Swaziland people over the age of 25 accounted for more than two thirds of adult infections yet very few HIV prevention programmes are designed for older people.

Funding for HIV prevention has become the smallest percentage of the HIV budgets of many countries. For example in Swaziland, just 17% of the country's total budget for AIDS was spent on prevention despite a national HIV prevalence rate of 26%. In Ghana, the prevention budget was cut in 2007 by 43% from 2005 levels.

Building capacity: new social networking site for global AIDS community

Building on the need to maximize results and to better connect the 33.4 million people living with HIV and the millions of people who are part of the AIDS response, UNAIDS has launched This social networking site is open to the community and is free. aims to expand informal and established networks to include more people interested in HIV to maximize resources for a stronger AIDS response. The premise behind AIDSspace is simple: if hundreds of millions of people can connect on some of the most popular social networking sites (e.g. Facebook, LinkedIn, MySpace, Twitter, YouTube) to connect, exchange ideas, post and share HIV-related content, they can do the same for HIV related content—including key policies, case studies, multimedia materials, conference posters, reports and other essential resources. Users can also find and post jobs and reviews on service providers on

PEPFAR & the Global Fund Collaborate to Treat 3.7 Million Living with HIV/AIDS

Programs Jointly Support Majority of 4 Million on Treatment in Low and Middle-Income Countries

1 December 2009

Washington - The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria announced today that the two programs are jointly supporting antiretroviral treatment for nearly 3.7 million of the estimated 4 million individuals in low and middle-income countries who currently receive treatment globally.

Through its partnerships with more than 30 countries through September 2009, PEPFAR has provided direct support for life-saving antiretroviral treatment for over 2.4 million men, women and children. The Global Fund has supported treatment for 2.5 million people worldwide. Approximately 1.3 million people receive treatment supported by both PEPFAR bilateral programs and the Global Fund, and thus are counted in the totals for each organization. These numbers reflect the strong country-level partnership between PEPFAR and the Global Fund. For example, in India, U.S. Government programs provide technical assistance to treatment services and the antiretroviral drugs are provided by the Global Fund.

PEPFAR and the Global Fund enjoy a complementary and supportive relationship in the fight against HIV and AIDS worldwide. In order to exploit synergies, PEPFAR and Global Fund-financed programs coordinate at the country level to ensure that resources are used efficiently and effectively. Collaboration and coordination are crucial to the efficient use of money and for making further progress in providing AIDS treatment and care to the millions still in need.

PEPFAR is the largest commitment by any nation to combat a single disease in history. Through PEPFAR, U.S. Government is the first and largest donor to the Global Fund, contributing $3.5 billion to date, with additional pledges that will bring the total U.S. Government contribution to $4.5 billion.

In addition to significant support for antiretroviral treatment, in FY 2009 alone, PEPFAR directly supported more than 11 million people with care and support programs. Throughout its history, PEPFAR’s efforts around prevention of mother-to-child transmission programs allowed nearly 340,000 babies of HIV-positive mothers to be born HIV-free. More than 4 million orphans and vulnerable children have been assisted by the program.

With US$ 9.3 billion disbursed to more than 550 programs so far, the Global Fund currently distributes a quarter of all international financing for AIDS globally, as well as two-thirds for TB and malaria.

The Global Fund is a unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts dealing with the three diseases.

Since its creation in 2002, the Global Fund has become the dominant financing vehicle for programs to fight AIDS, tuberculosis and malaria, with approved funding of US$ 18.7 billion for more than 600 programs in 144 countries. To date, programs supported through the Global Fund have saved 4.9 million lives through providing AIDS treatment for 2.5 million people, anti-tuberculosis treatment for 6 million people and the distribution of 104 million insecticide-treated bed nets for the prevention of malaria.


For more information, please contact:

Andrew Hurst - The Global Fund
Office: + 41 58 791 16 72
Mobile: + 41 79 561 68 07

Jennifer L. Peterson - Office of the U.S. Global AIDS Coordinator Office: + 1 202 663 2338

Information on the work of the Global Fund is available at

Information on the work of PEPFAR is available at

Address by President Jacob Zuma on the occasion of World AIDS Day, Pretoria Showgrounds

1 December 2009

Deputy President Kgalema Motlanthe, The Minister of Health Dr Aaron Motsoaledi and all Ministers and Deputy Ministers present, Premier of Gauteng Nomvula Mokonyane and MECs present, Executive Mayor of Tshwane Dr Gwen Ramokgopa, Deputy Chairperson of the South African National AIDS Council, Mark Heywood, Members of the diplomatic corps, UN AIDS Executive Director Michel Sedibe and all representatives of international agencies, Fellow South Africans,

Today we join millions of people across the globe to mark World AIDS Day.

We join multitudes who have determined that this epidemic cannot be overcome without a concerted and coordinated effort.

We join millions who understand that the epidemic is not merely a health challenge. It is a challenge with profound social, cultural and economic consequences.

It is an epidemic that affects entire nations. Yet it touches on matters that are intensely personal and private.

Unlike many others, HIV and AIDS cannot be overcome simply by improving the quality of drinking water, or eradicating mosquitoes, or mass immunisation.

It can only be overcome by individuals taking responsibility for their own lives and the lives of those around them.

Fellow South Africans,

As a country, we have done much to tackle HIV and AIDS.

In every sector of society, there are individuals and groups who have worked tirelessly to educate, advocate, care, treat, prevent and to break the stigma that still surrounds the epidemic.

Today, we wish to acknowledge their dedicated efforts.

As government we are ready to play our role of leadership, building on the foundation that has been laid over the past 15 years.

Under the leadership of Presidents Nelson Mandela, Thabo Mbeki and Kgalema Motlanthe, the democratic government has put in place various strategies to comprehensively deal with HIV and AIDS, tuberculosis and sexually transmitted infections.

Working with other sectors through the South African National AIDS Council, we have managed to harness unity in confronting this scourge.

The amount of resources dedicated to prevention, treatment and care has increased with each successive year.

But it is not enough. Much more needs to be done.

We need extraordinary measures to reverse the trends we are seeing in the health profile of our people.

We know that the situation is serious. We have seen the statistics.

We know that the average life expectancy of South Africans has been falling, and that South Africans are dying at a young age.

We have seen the child-headed and granny-headed households, and have witnessed the pain and displacement of orphans and vulnerable children.

These facts are undeniable. We should not be tempted to downplay the statistics and impact or to deny the reality that we face.

At the same time, the epidemic is not about statistics. It is about people, about families, and communities.

It is about our loved ones.

For many families, it is a burden that they have to bear alone, fearful of discrimination and stigma.

Dear Compatriots,

Now is not the time to lament. It is the time to act decisively, and to act together.

Our message is simple. We have to stop the spread of HIV. We must reduce the rate of new infections. Prevention is our most powerful weapon against the epidemic.

All South Africans should take steps to ensure that they do not become infected, that they do not infect others and that they know their status.

Each individual must take responsibility for protection against HIV. To the youth, the future belongs to you.

Be responsible and do not expose yourself to risks.

Parents and heads of households, let us be open with our children and educate them about HIV and how to prevent it.

Ladies and gentlemen,

We are still marking the 16 days of activism against violence on women and children. During this period, it is important that we also remember to uphold the rights of women and children, including their right to protection from infection with HIV.

Many women are unable to negotiate for protection due to unequal power relations in relationships.

As we mark the International Day of Persons with Disabilities on Thursday, the 3rd of December, let us remember the impact of HIV on persons with disability.

We have to tailor government programmes and messages to also speak to the needs of this sector.

Fellow South Africans,

To take our response a step forward, we are launching a massive campaign to mobilise all South Africans to get tested for HIV.

Every South African should know his or her HIV status. To prepare for a continuous voluntary testing campaign, we would like to announce a few new measures, to expand our response.

All children under one year of age will get treatment if they test positive. Initiating treatment will therefore not be determined by the level of CD cells.

This decision will contribute significantly towards the reduction of infant mortality over time.

All patients with both tuberculosis (TB) and HIV will get treatment with anti-retrovirals if their CD4 count is 350 or less. At present treatment is available when the CD4 count is less than 200. TB and HIV/AIDS will now be treated under one roof.

This policy change will address early reported deaths arising from undetected TB infection among those who are infected with HIV.

We have taken this step, particularly on learning that approximately 1% of our population has TB and that the co-infection between TB and HIV is 73%.

All pregnant HIV positive women with a CD4 count of 350 or with symptoms regardless of CD4 count will have access to treatment. At present HIV positive pregnant women are eligible for treatment if their CD4 count is less than 200.

All other pregnant women not falling into this category, but who are HIV positive, will be put on treatment at fourteen weeks of pregnancy to protect the baby. In the past this was only started during the last term of pregnancy.

In order to meet the need for testing and treatment, we will work to ensure that all the health institutions in the country are ready to receive and assist patients and not just a few accredited ARV centres. Any citizen should be able to move into any health centre and ask for counselling, testing and even treatment if needed.

The implementation of all these announcements is effective from April 2010. Institutions are hard at work to ensure that systems are in place by the 31st of March.

What does this all mean? It means that we will be treating significantly larger numbers of HIV positive patients. It means that people will live longer and more fulfilling lives.

What does it NOT mean? It does not mean that we should be irresponsible in our sexual practices.

It does not mean that people do not have to practice safer sex. It does not mean that people should not use condoms consistently and correctly during every sexual encounter.

We can eliminate the scourge of HIV if all South Africans take responsibility for their actions.

I need to re-emphasise at this point that we must intensify our prevention efforts if we are to turn off the tap of new HIV and TB infections. Prevention is our most powerful and effective weapon.

We have to overcome HIV the same way that it spreads - one individual at a time. We have to really show that all of us are responsible.

The HIV tests are voluntary and they are confidential. We know that it is not easy. It is a difficult decision to take.

But it is a decision that must be taken by people from all walks of life, of all races, all social classes, all positions in society. HIV does not discriminate.

I am making arrangements for my own test. I have taken HIV tests before, and I know my status. I will do another test soon as part of this new campaign. I urge you to start planning for your own tests.

Ladies and gentlemen,

We are also mindful of the social impact of the epidemic, and continue to provide psycho-social support and home based care, through the Home Community Based Care and child care programmes of government.

Let me use this opportunity to salute all our caregivers including those neighbours who assist and support families in distress.

We also thank our international partners, who continue to provide material support to our campaign against AIDS.

On this day, our hearts go out to all South Africans who are in distress as a result of this epidemic. To families looking after sick relatives, we wish you strength. We understand what you are going through.

To those who have lost their loved ones to the epidemic we share your pain, and extend our deepest condolences.

Fellow South Africans,

At another moment in our history, in another context, the liberation movement observed that the time comes in the life of any nation when there remain only two choices: submit or fight.

That time has now come in our struggle to overcome AIDS.

Let us declare now, as we declared then, that we shall not submit.

We have no choice but to deploy every effort, mobilise every resource, and utilise every skill that our nation possesses, to ensure that we prevail in this struggle for the health and prosperity of our nation.

History has demonstrated the strength of a nation united and determined.

We are a capable, innovative and motivated people.

Together we fought and defeated a system so corrupt and reviled that it was described as a crime against humanity.

Together we can overcome this challenge.

Let today be the dawn of a new era.

Let there be no more shame, no more blame, no more discrimination and no more stigma.

Let the politicisation and endless debates about HIV and AIDS stop.

Let this be the start of an era of openness, of taking personal responsibility, and of working together in unity to prevent HIV infections and to deal with its impact.

Working together, we can achieve these goals!

I thank you.

Issued by: The Presidency
1 December 2009

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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