[Ip-health] Call to action on AIDS mortality: Letter from 92 civil society organizations to UNAIDS Executive Director candidates

PERFECT, Chase cperfect at coalitionplus.org
Wed Jul 24 14:33:15 PDT 2019

 Hi all,

Sharing below a letter signed by 92 civil society organizations that
decries the unacceptably high number of avoidable AIDS-related deaths. The
global response remains way off track of its targets to reduce AIDS
mortality. The letter calls on UNAIDS Executive Director candidates to
assert strong leadership in the development and implementation of a
mortality reduction plan.

***Apologies for cross-posting***


*Subject: Breaking the silence on needless AIDS deaths*

To the attention of the UNAIDS Executive Director Candidates:
Salim Abdool Karim

Sani Aliyu

Chris Beyrer

Winnie Byanyima

Bernard Haufiku

Dear UNAIDS Executive Director Candidates,

In 2016, the UN General Assembly set a Fast-Track target to reduce annual
AIDS-related deaths to 500,000 by 2020.  One year out from 2020, countries
remain wildly off target for the single most important measure of success
in confronting the AIDS epidemic. The silence that accompanies this
continuing crisis of mortality requires a wake-up call from the next UNAIDS
Executive Director.

In July 2018, UNAIDS’ epidemic update showed that reductions in AIDS
mortality have nearly ground to a halt, with the lowest annual reduction in
AIDS deaths in over a decade. At the Amsterdam International AIDS
Conference later that month, a number of civil society organizations and
activists called for UNAIDS to develop a robust plan to forcefully confront
the failure on AIDS death reduction.

This request was made again, along with specific recommendations, in a
letter signed by over 40 community-based and civil society organizations in
September 2018. In the year since, we have seen little change in the broad
neglect of AIDS-related deaths.

Scale up of early-initiated antiretroviral treatment coverage is the single
most important intervention to prolong the lives of people living with HIV.
However, this alone is not enough to stem the tide of preventable AIDS
deaths. People need access to optimal tools that screen, diagnose, treat,
and prevent the leading killers of people with HIV—TB and cryptococcal

The reduction of annual AIDS deaths, including those associated with late
treatment, has unfortunately stalled. Where we should be seeing a
predictable downward trajectory towards the 500,000 target, instead we see
an awful trend of low reduction rates, including an estimate of only 30,000
reductions in 2018. This should be a siren call to the global health
community, given that it represents the lowest reduction in annual deaths
since 2005 and leaves annual mortality at over 700,000 AIDS deaths in 2018.
The millions of human beings expected to die of AIDS before 2030 would find
the ambition to End AIDS absolutely necessary, but talk of its imminent
elimination premature.

The next Executive Director of UNAIDS must break this silence and more
directly confront the crisis at hand. This begins with recognition of key

●      Despite being preventable and curable, tuberculosis accounts for the
majority of deaths among PLHIV: one in three deaths in 2017[1] <#_ftn1>.
However, the majority of countries will not meet the target to reduce these
senseless deaths by 75% by 2020; only 5 countries have met this target[2]

●      100,000 children under 15 died from AIDS-related causes in 2018
(38,000 from West and Central Africa)[3] <#_ftn3>. Children under the age
of 4 living with HIV are more likely to die of an AIDS-related cause than
any other age group.[4] <#_ftn4> While children make up 5% of the global
HIV/AIDS epidemic, they account for 15% of AIDS-related deaths.[5] <#_ftn5>

●      A substantial number of deaths occur among those who have already
initiated ARV therapy but are experiencing treatment failure or falling out
of care.[6] <#_ftn6>

●      West and Central African PLHIV population represented 8% of the
global PLHIV population but 20% (160,000) of total AIDS-related deaths in

●      In 2018, there were 53,000, 71,000 and 54,000 AIDS deaths in
Nigeria, South Africa and Mozambique, respectively.  In 2018, there were
200,000 AIDS deaths in Asia and the Pacific.[7] <#_ftn7>

●      Globally, cryptococcal meningitis is responsible for an estimated
15% of AIDS-related deaths[8] <#_ftn8>.

The next leader of UNAIDS must commit to the development of a concrete plan
to address AIDS deaths and mobilize country-level support to assist in its
implementation. In addition to emphasizing the importance of picking up the
pace of scale-up of timely initiation of ART for all people living with
HIV, for regular viral load testing, and for psycho-social support systems
to durably connect people to quality care, the plan should include support

●      Rollout of the WHO-recommended package of care for AIDS-related
advanced HIV diseases; this package of care encompasses testing, treatment,
and prevention to address the leading opportunistic infectious killers.
This includes LAM and CrAg testing for people with advanced HIV, and
baseline CD4 for those who are treatment naive or in need of evaluation
following treatment interruption and return to care. As such, CD4 cell
count testing remains important for all people living with HIV (i) at
baseline (i.e. first diagnosis), (ii) for those clinically suspected of, or
diagnosed (via a detectable viral load) with, ART failure, and (iii)
following treatment interruption.  Relying on clinical staging alone risks
missing substantial numbers of people living with HIV who face severe
immune suppression but aren't yet symptomatic.

●      Provision of shorter rifapentine-based preventive therapy [3HP
and/or 1HP] or Q-TIB, if not available,  for TB prevention, as well as the
rapid development of pediatric formulations of this important TB Preventive
Treatment option and making 3 months of a fixed dose combination of
dispersible rifampin and isoniazid (3RH) available for younger children;
scale up in access to these medicines is necessary to meet the UNGA’s 2018
commitment to provide preventive treatment to 6 million people living with
HIV and AIDS by 2022 (https://www.who.int/tb/unhlmonTBDeclaration.pdf)

●      More robust country-level measurement of the causes and scale of
AIDS-related mortality

We call upon candidates for UNAIDS Executive Directorship to show their
commitment to fight HIV mortality, to *break the silence on this crisis*,
and to set out their plans to maximize UNAIDS’ contribution to delivering
on the global target of halving AIDS deaths.

Signatory organizations (92):

1.     100% LIFE, Ukraine

2.     Asociación Brasilera Interdisciplinar de SIDA (ABIA), Brazil

3.     Access Care Treatment and Support Ghana (ACTSGHANA), Ghana

4.     AIDES, France

5.     Association de Lutte Contre le Sida (ALCS), Morocco

6.     Alliance Burundaise contre le SIDA et pour la promotion de la santé

7.     American Medical Student Association (AMSA), USA

8.     Alliance Nationale des Communautés pour la Santé (ANCS), Senegal

9.     Association Nationale de Soutien aux Séropositifs et Malade du Sida
(ANSS), Burundi

10.  Asociatia Romana Anti-SIDA (ARAS), Romania

11.  ARCAD-SIDA, Mali

12.  Asia Pacific Council of AIDS Service Organizations (APCASO)

13.  CENTA, Tanzania

14.  Centre for Health Human Rights and Development (CEHURD), Uganda

15.  Centre for Participatory Research and Development CEPARD, Uganda

16.  Coalition for Health Promotion and Social Development (HEPS Uganda)

17.  Coalition of Civil Society Networks on HIV/AIDS in Nigeria

18.  Coalition of Women Living with HIV and AIDS (COWLHA), Malawi

19.  Coalition PLUS

20.  Convergence Communautaire du Faso (COCOFA), Burkina Faso

21.  Coalition des Organismes communautaires Québécois de lutte contre le
Sida (COCQ-SIDA), Canada

22.  Commonwealth HIV & AIDS Action Group (CHAAG)

23.  Consolation East Africa, Kenya

24.  Drugs for Neglected Diseases initiative (DNDi)

25.  Differentiated Service Delivery Umoja Tanzania (DSDUT), Tanzania

26.  Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)

27.  Empower India

28.  Fundación Grupo Efecto Positivo, Argentina.

29.  Grupo de Ativistas em Tratamentos (GAT), Portugal

30.  Global Coalition of Women against AIDS in Uganda

31.  Global Network of People Living with HIV (GNP+)

32.  Groupe Sida Genève, Switzerland

33.  Health GAP (Global Access Project)

34.  Health Poverty Action, UK

35.  Health Rights Action Group (HAG), Uganda

36.  Health Development Consultancy Service (HEDECS), Cameroon

37.  HIV i-base, UK

38.  Hope After Rape, Uganda

39.  Housing Works

40.  Human Right Research Documentation Centre (HURIC), Uganda

41.  Human Rights Awareness and Promotion Forum (HRAPF), Uganda

42.  Instituto para el Desarrollo Humano (IDH), Bolivia

43.  Ifarma, Colombia

44.  Initiative for Prisoners Health Rights, Uganda

45.  Intercambios, Puerto Rico

46.  International Community of Women Living with HIV/AIDS (ICW)

47.  International Treatment Preparedness Coalition (ITPC), Global

48.  International Network of Religious Leaders Living with or Personally
Affected by HIV and AIDS (INERELA+)

49.  Kampala District Forum of PLHIV Networks (KADFO), Uganda

50.  KARDS, Kenya

51.  Kimirina, Ecuador

52.  Koinonia Community, Kenya

53.  Lesotho Network of People Living With HIV/AIDS (LENEPWHA)

54.  Makerere Women Development Association, Uganda

55.  Mama’s Club, Uganda

56.  Mariam foundation, Uganda

57.  Médecins Sans Frontières (MSF)

58.  MPact Global Action for Gay Men’s Health & Rights

59.  National Community of Women Living with HIV, Uganda

60.  National Forum for People Living with HIV/AIDS (NAFOPHANU), Uganda

61.  Prévention Information Lutte contre le Sida (PILS), Mauritius

62.  Partnership to Inspire, Transform and Connect the HIV response
(PITCH), Uganda

63.  Positive Men’s Union, Uganda

64.  Positive Young Women Voices

65.  Prevention Care International (PCI), Uganda

66.  Red Argentina de Personas Positivas (Redar Positiva), Argentina.

67.  Red Latinoamericana por el Acceso a Medicamentos (RedLAM).

68.  Réseau des Populations Clés, (ROPCI), Cote d’Ivoire


70.  Responsabilité, Espoir, Vie, Solidarité (REVS+), Burkina Faso

71.  Samasha, Uganda

72.  SECTION27, South Africa

73.  Southern and Eastern African Trade Information and Negotiations
Institute (SEATINI)


75.  Support on AIDS and Life Through Telephone Helpline (SALT), Uganda

76.  Tanzania Network for People xhoe Use Drugs (TaNPUD), Tanzania

77.  Tanzania Blue Hearts, Tanzania

78.  Tanzania Network of Women Living with HIV (TNW+), Tanzania

79.  The Action Group for Health, Human Rights and HIV/AIDS Uganda

80.  Treatment Action Campaign (TAC), South Africa

81.  Treatment Action Group (TAG), US

82.  Tusitukirewamu, Uganda

83.  L'Union Congolaise des Organisations des Personnes Vivant avec le VIH
(UCOP+), Congo

84.  Uganda Health Sciences Press Association, Uganda

85.  Uganda Network of AIDS Service Organisations (UNASO)

86.  Uganda Network of Young People Living with HIV

87.  Uganda Network on Law Equality and Ethics (UGANET), Uganda

88.  Uganda Young Positives (UYP), Uganda

89.  Uganda's Young Positive Networks (UNYPA), Uganda

90.  Vietnam Network of People Living with HIV/AIDS (VNP+), Vietnam

91.  White Ribbon Alliance (WRA), Uganda

92.  Women Fighting AIDS in Kenya (WOFAK), Kenya


[1] <#_ftnref1> WHO. Global TB Report 2018. Available from:

[2] <#_ftnref2> UNAIDS. UNAIDS reports mixed progress towards reaching the
2020 target of reducing TB deaths among people living with HIV by 75%.
Press release. [Online]. 2019 Mar 22 [Cited 2019 Jun25]. Available from:

[3] <#_ftnref3> UNAIDS 2019 Data. Available from:
http://aidsinfo.unaids.org/ (Accessed July 17th, 2019)

[4] <#_ftnref4> UNAIDS 2019 Data. Available from:
http://aidsinfo.unaids.org/ (Accessed July 17th, 2019)

[5] <#_ftnref5> Extrapolated from UNAIDS Data. Available from:
https://aidsinfo.unaids.org/ (Accessed 7/3/2019).

[6] <#_ftnref6> Ousley et al. High Proportions of Patients With Advanced
HIV Are Antiretroviral Therapy Experienced: Hospitalization Outcomes From 2
Sub-Saharan African Sites, Clinical Infectious Diseases, Volume 66, Issue
suppl_2, 1 April 2018, Pages S126–S131, https://doi.org/10.1093/cid/ciy103

[7] <#_ftnref7> UNAIDS 2019 Data. Available from:
http://aidsinfo.unaids.org/ (Accessed July 17th, 2019)

[8] <#_ftnref8> Radha Rajasingham, Rachel M Smith, Benjamin J Park, et al.
Global burden of disease of HIV-associated cryptococcal meningitis: an
updated analysis. Lancet Infec Dis [Online]. 2019 June 25. Cited 2019 June
25. Available from: 10.1016/S1473-3099(17)30243-8.

Chase Perfect
Access to Medicines Policy Officer
HIV/HCV Drug Affordability Project
Coalition Plus (Paris, France)

Skype ID: cperfect1984
Telephone: +33 (0)6 16 28 10 44
What's App: +33 6 16 28 10 44

[image: PLUS - Coalition Internationale SIDA]

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