The need for optimal coordination to combat HIV/AIDS

Article, 12.12.2016

Switzerland hosted a meeting of UNAIDS’s governing board in Geneva from 6 to 8 December 2016. In its capacity as chair of the board, it invited all members to a day of site visits in the Geneva region. The aim was to highlight the importance of highly effective coordination between prevention services and patient care in the field of HIV/AIDS.

A group of visitors listens as a senior staff member explains something in the drug consumption room in Quai 9.
A UNAIDS delegation starts the day visiting the premises and staff of the Quai 9 centre, a reception facility for drug addicts. © UNAIDS

UNAIDS’s governing board, which Switzerland is chairing this year, met in Geneva from 6 to 8 December 2016. Following the meeting, the SDC and the Federal Office of Public Health jointly organised a series of site visits for members of the governing board. 

Over 20 representatives of countries, NGOs and UN agencies visited the ‘Quai 9’ centre, a reception facility for drug addicts, the ‘Groupe sida Genève’ (Geneva AIDS Group), Checkpoint, an adjoining health and information centre open to gays and bisexuals, the HIV/AIDS unit at Geneva University Hospital and finally the Champ-Dollon prison. 

Half of HIV carriers without access to care

The keyword throughout the day of visits was coordination. According to figures recently published by UNAIDS, half of people who are HIV positive are not receiving adequate treatment, often simply due to them being unaware that they are HIV carriers. This explains why prioritising testing and access to information for everyone is vital. This requires optimal coordination between the public and private services involved in preventing HIV/AIDS and in patient care, as well as with the groups at risk concerned. This requires optimal coordination between public and private services active in the prevention of HIV/AIDS and the provision of care to patients and at-risk groups.

In 2015, the number of HIV carriers worldwide exceeded 36 million. The goal adopted by the international community of eradicating the epidemic by 2030 will require strong political will to utilise the prevention and treatment instruments developed to date. 

Susanne Amsler, head of HIV/AIDS at the SDC and a member of the Swiss delegation on UNAIDS’s governing board, sheds light on the aim of the visits organised in Geneva. 

What did participants learn during the site visits?

We wanted to provide an insight into the quality of HIV/AIDS care and prevention in Switzerland. Switzerland has succeeded in significantly reducing its infection rate over a 20-year period, especially amongst drug addicts, thanks to two key factors. Its four-pronged policy on drugs (prevention, treatment, risk reduction, repression and regulation of the market) and also the excellent coordination established between all services and actors involved. The healthcare sector cannot work alone in the face of the HIV/AIDS risk. It relies upon cooperation with social institutions, the police, the prisons and people living with HIV/AIDS. The Sustainable Development Goals of the 2030 Agenda serve as a reminder. Problems have to be tackled using a multi-sectoral approach. In this respect, Switzerland can provide inspiration for many other countries. 

Exactly how will the SDC go about achieving this coordination priority in the countries where it operates?

The first step is to take account of the specific characteristics and requirements in each context. The nature of the epidemic can vary greatly from one region to another and from one country to the next or even within countries. In Europe and central Asia, for example, drug addicts are the main at-risk group. In Africa, it is primarily the general population that is affected by HIV/AIDS with an above-average proportion of women and young people suffering from it. The idea of taking such regional situations into account – and providing suitable solutions – represents a new element in UNAIDS’s approach. In its cooperation activities in Africa, the SDC has always recognised the need to support national healthcare systems as coalitions of well-coordinated actors. The fight against HIV goes hand in hand with providing young people with access to sexual and reproductive health services. We sometimes support projects aimed at a specific population group, such as prisoners in southern Africa, but these are exceptions. Our goal is really to achieve universal healthcare coverage. 

Are the at-risk groups always properly involved in the prevention measures?

That depends to a great extent on the context and which groups or communities you mean. Gender inequality and discrimination against various groups primarily affected by the risk of HIV/AIDS – such as drug addicts, sex workers, men who have sex with men and prisoners – mean people are alienated in many countries. Things are nevertheless changing. I recently had the opportunity to visit Beijing to observe how the issue of HIV/AIDS is dealt with there and I witnessed some encouraging signs in relation to the involvement of groups at risk. Switzerland is heavily involved in this issue within UNAIDS. In the end, we succeeded in getting the UN to set a clear objective last June – 30% of HIV/AIDS-related services are to be provided by the communities themselves by 2030. This refers to the groups at risk or the inhabitants of a village, for example. The meeting of UNAIDS’s governing board which has just taken place in Geneva addressed this point by encouraging the active support of the member countries and communities. 

In what way?

Firstly by encouraging the exchange of best practice in terms of cooperation. UNAIDS can act as a facilitator and convey information between countries. Then by supporting the national authorities in their task of identifying the competencies available within the communities. In this way government healthcare services can rely upon dependable and effective partners to reduce the impact of HIV/AIDS.