More than 3 million people died of AIDS and nearly 5 million people became newly infected with HIV in 2004. There were just under 40 million people living with the disease - nearly half of them women - yet fewer than 1 in 5 people at high risk of infection had access to proven prevention interventions. The number of AIDS orphans climbed to 15 million, 12 million of whom live in sub-Saharan Africa.
The ICPD noted the severity of HIV/AIDS in 1994 and, responding to the expansion of the epidemic, the review five years later (ICPD+5) defined specific and urgent goals. Key follow-up actions specified that HIV/AIDS prevention should be "an integral component" of sexual and reproductive health programmes at the primary care level. Strengthening this approach to services was a UNFPA priority in 2004, complementing ongoing commitments to women and young people and to condom programming.
ACTION AGAINST HIV/AIDS
UNFPA took every opportunity in 2004 to advocate universal access to reproductive health as fundamental to reducing poverty and ending the HIV/AIDS crisis. As a co-sponsor of the global United Nations Joint Programme on HIV/AIDS (UNAIDS), UNFPA contributed leadership at many levels, including participation in each country's United Nations Theme Group on HIV/AIDS.
- A high-level global consultation in June called for much stronger links between HIV/AIDS and sexual and reproductive health to bring about more relevant and cost-effective programmes. Leaders from governments, UN agencies, NGOs and the donor community endorsed "The New York Call to Commitment" at a conference organized by UNFPA and UNAIDS with Family Care International.
- UNFPA and the Mano River Union secretariat signed an agreement to prevent the spread of HIV/ AIDS among refugees, the internally displaced and people living with HIV/AIDS in Côte d'Ivoire, Guinea, Liberia and Sierra Leone. Also in 2004, UNFPA conducted a survey on HIV prevention among UN peacekeepers in Sierra Leone and an evaluation of vulnerable groups in the country.
- Tea plantation communities in Bangladesh were the focus of a UNFPA initiative, with funding from Sweden, to promote prevention by raising awareness, providing reproductive health supplies and services, and advocating HIV/AIDS policies for tea companies and trade unions.
- The Government of Afghanistan established the country's first voluntary counselling and testing centre, inaugurated in November in Kabul, with support from UNFPA. The refurbished centre is a model site for delivering HIV/AIDS services, training and the standardization of procedures and quality assurance.
- In Honduras, UNFPA provided a grant to support prevention programmes and workshops on income generating activities at a hospice where most patients are living with HIV/AIDS. Dignified care and 24-hour nursing are provided to even the poorest with no means of income or family support.
- New guidelines on HIV voluntary counselling and testing and its integration into reproductive health services were published by UNFPA and the International Planned Parenthood Federation (IPPF). The guidelines were based in part on pilot projects in Côte d'Ivoire and India, along with experiences in Ethiopia, Kenya and Rwanda.
- To help pregnant women and those who have just given birth avoid HIV infection, UNFPA and EngenderHealth produced the programming guide HIV Prevention in Maternal Health Services. The publication is for use by programme planners, health managers, and trainers to strengthen prevention and referral services for HIV and other sexually transmitted infections (STIs).
HAITI'S GHESKIO CENTRES
In centres like this one in Port-au-Prince, Haiti, UNFPA works with the Ministry of Health and GHESKIO, a national NGO, to promote the integration of voluntary testing and counselling with services that prevent mother-to-child transmission.
GHESKIO provides integrated HIV/AIDS services that include information on transmission and prevention, individual and group counselling, and psychological and social support.
WOMEN AND AIDS
Women's empowerment and equality - goals central to the ICPD - are critical to attaining reproductive health for all, and to halting HIV/AIDS. The ICPD's action plan noted that the "social and economic disadvantages that women face make them especially vulnerable to sexually transmitted infections, including HIV."
Women now number nearly half of all people infected with HIV, and infections are increasing dramatically among young women. In sub-Saharan Africa, 57 per cent of adults with HIV are women. UNFPA supports urgently needed action to respond to the increasing threat to women and girls, including more responsible roles for boys and men.
- The Global Coalition on Women and AIDS (GCWA) was launched by UNAIDS in February. UNFPA was designated as a co-convener with IPPF and YoungPositive of the action area "HIV prevention among women and girls", addressing access to information and services and advocating an end to forced child marriage.
- Participants endorsed "The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children" at a consultation convened in May by WHO and UNFPA. The Call reinforces a comprehensive approach to preventing mother-to-child transmission that also prevents unintended pregnancy and provides treatment and support for HIV-infected women and their families.
EMPOWERING WOMEN, REVERSING HIV/AIDS
Women are bearing the brunt of the HIV/AIDS epidemic, and strategies to reverse it cannot succeed unless women and girls are empowered to reclaim their rights, says an action-oriented report by UNFPA, UNAIDS and UNIFEM released during the XV International AIDS Conference in July. Noting that 17 million women between the ages 15 and 49 are infected, Women and HIV/AIDS: Confronting the Crisis documents the devastating impact of AIDS on women and girls and highlights how discrimination, poverty and gender-based violence help fuel the epidemic. It also recommends realistic strategies for response, which include ensuring that adolescent girls and women have the knowledge and means to prevent HIV infection, ensuring equal and universal access to treatment, recognizing and supporting home-based caregivers of AIDS patients and orphans, promoting girls' primary and secondary education and women's literacy, promoting zero tolerance of all forms of violence against women and girls, and promoting and protecting the human rights of women and girls.
YOUNG PEOPLE AND HIV/AIDS
In 2004, some 10 million young people were living with HIV/AIDS, with up to 6,000 people aged 15 to 24 infected every day. UNFPA continued to place high priority on immediate action to address the vulnerabilities of young people in ways that are ageappropriate, sensitive to gender and culture, and open to their participation.
- More than 40 youth organizations took part in the XV International AIDS Conference in July in Bangkok, Thailand, where UNFPA facilitated youth participation in plenary sessions, panel discussions and networking activities. UNFPA also supported the creation of a 600-member Global Youth Coalition on AIDS to enhance knowledge-sharing and capacity building among local, regional and global HIV/AIDS organizations.
- Young people in the Dominican Republic, Egypt and Panama drafted advocacy action plans to rally support for HIV prevention as part of the UNFPA supported Global Youth Partners Initiative. Similar advocacy efforts in Bangladesh and Nepal were undertaken by the Reproductive Health Initiative for Youth in Asia (RHIYA), with support from UNFPA and the European Union, and also in Lebanon and Ukraine.
- Fifty young people were among the 145 participants from 34 countries attending a UNFPA workshop to scale up youth-friendly programmes in HIV prevention. Held in Nairobi in November, it led to the creation of the Youth Network on Population and Development.
- A regional project in the Arab States to integrate reproductive health education, including HIV prevention, into youth programmes was carried out by UNFPA with the American University of Beirut, Lebanon. The project produced a peer education training manual, held workshops for youth focal points and compiled studies on the reproductive health of young people in the Arab region. Confronting the HIV/AIDS Crisis.
- At the Bangkok conference, UNFPA launched an inter-agency report, At the Crossroads: Accelerating Youth Access to HIV/AIDS Interventions. The report documents how young people lack access to critical youth-friendly information and services and life skills to prevent HIV infection as well as to care and treatment when living with HIV/AIDS.
At a youth fair in the Maldives, young people seek information on HIV/AIDS and other reproductive health issues from a booth set up by UNFPA.
As the world's most available and effective technology to reduce the sexual transmission of HIV and other STIs, the condom is widely promoted and distributed by UNFPA, which is also the designated UNAIDS convening agency on condom programming.
- The critical role of condoms in HIV prevention and treatment was affirmed by UNAIDS, WHO and UNFPA. A position statement issued in July cited research proving effectiveness, and asserted that condoms must be readily available, free or at low cost, and promoted in ways that overcome obstacles to their use, including issues of gender and culture.
- UNFPA initiated a project for female condom programming with pilot activities in Cambodia, India, Nigeria, Papua New Guinea and Sri Lanka that are to be expanded to 20 countries in the coming years. In addition to increasing access and use, the project collects examples of good practice in condom promotion.
- UNFPA and Johns Hopkins University developed a set of Frequently Asked Questions about the correct and consistent use of male and female condoms and the social and cultural factors affecting their use for publication online and on CD-ROM.
- In the Caribbean, promotion of the female condom continued through the mass media and through outreach at innovative and receptive sites such as beauty parlors and barbershops.
EDUCATION AND ADVOCACY
The ICPD called for global action to raise awareness about the disastrous consequences of HIV/AIDS, to provide information on means of prevention, and to address stigma, discrimination and issues of human rights. The leadership role played by UNFPA in raising awareness of HIV/AIDS was recognized throughout the year at events marking the ICPD's 10th anniversary.
- Parliamentarians from English- and Dutch speaking Caribbean countries issued a declaration of commitment to preventing HIV infection and a set of country-specific action plans at a conference in June in Trinidad and Tobago, organized by UNFPA. Another conference in October in Fiji brought together parliamentarians from 17 Pacific countries, including Australia and New Zealand, to reaffirm their commitment to fighting HIV/AIDS in their region.
- Facts about HIV prevention were included in Achieving the MDG Goals by Promoting Gender Equality, a DVD produced by UNFPA for use in education and empowerment activities for women participating in micro-credit activities in poor communities, including those severely affected by HIV/AIDS.
- UNFPA produced a six-minute video in which peer educators and trainers talk about trying to prevent the spread of HIV/AIDS in Eastern Europe and Central Asia. The young people, who were filmed at a training programme in the former Yugoslav Republic of Macedonia, exchange information regularly through the Y-PEER interactive website and network.