The Fourth Stocktaking Report, produced by UNICEF, in partnership with UNAIDS, WHO and UNFPA is an
annual report that examines data on progress, emerging evidence, case studies of best practices and
current knowledge and practice for children as they relate to the 'Four Ps':

• Preventing mother-to-child transmission of HIV
• Paediatric HIV care and treatment
• Preventing HIV infection among adolescents and young people
• Protecting and supporting children affected by HIV and AIDS

UNAIDS Outlook 2010, a new publication launched today, explores new ideas and ways to use the data collected in the AIDS Epidemic Update companion report.

The publication also poses a number of bold questions that call for a response: How can we use our knowledge of the HIV epidemic and response for more effective programming at country level? How do we become smarter about HIV prevention to make a real difference? What is the anatomy of a bad law from a human rights perspective?

Features include "Where does the Money for AIDS go?" exploring fund flows in the AIDS response and "Being the Change" digging deeper into issues on young people, sexuality and how behaviors are changing, mixed with captivating images and storytelling narratives to show the plight of individuals.

According to the 2009 AIDS Epidemic Update, the number of people living with HIV worldwide continued to grow in 2008, reaching an estimated 33.4 million. The total number of people living with the virus in 2008 was more than 20% higher than the number in 2000, and the prevalence was roughly threefold higher than in 1990.

The continuing rise in the population of people living with HIV reflects the combined effects of continued high rates of new HIV infections and the beneficial impact of antiretroviral therapy. As of December 2008, approximately 4 million people in low- and middle-income countries were receiving antiretroviral therapy-a 10-fold increase over five years.

In 2008, an estimated 2.7 million new HIV infections occurred. It is estimated that 2 million deaths due to AIDS-related illnesses occurred worldwide in 2008. The latest epidemiological data indicate that globally the spread of HIV appears to have peaked in  1996, when 3.5 million new HIV infections occurred. In 2008, the estimated number of new HIV infections was approximately 30% lower than at the epidemic's peak 12 years earlier.

This report is divided into separate chapters that summarize epidemiological trends in individual regions. While regional differences remain, several themes are discernible:

• AIDS continues to be a major global health priority;
• There is geographic variation between and within countries and regions;
• The epidemic is evolving;
• There is evidence of successes in HIV prevention;
• Improved access to treatment is having an impact;
• There is increased evidence of risk among key populations.

As part of its commitment to HIV prevention, the SADC Secretariat HIV and AIDS Unit convened the SADC HIV Prevention Meeting: Achieving Prevention Targets on 7-9 June 2009 in Johannesburg, South Africa. This was three years after the SADC Expert Think Thank Meeting on HIV Prevention in High-Prevalence Countries in Southern Africa, Maseru, Lesotho, that identified key drivers of theepidemic and made recommendations for an intensified response.

The June 2009 meeting discussed the degree of implementation of the key recommendations of the Maseru meeting and of the SADC HIV Prevention Strategy, reviewed the progress against UNGASS indicators and the SADC Epidemic Report, 2008, reviewed the successes, bottlenecks and the challenges experienced to date, and identified emerging evidence and issues and the highest priorities for HIV prevention in the coming period.

The purpose of this study  is to  provide strategic information  on key HIV-related indicators  for program  managers  and  policymakers  to  monitor  and  evaluate  prevention  programs  and  to  design  new strategies. The report summarizes levels and recent changes in 69 indicators of HIV-related knowledge, attitudes, and behaviors of women and men age 15-49 in 23 countries in sub-Saharan Africa. Data come from the two most recent rounds of population-based, nationally representative Demographic and Health Surveys (DHS) conducted between 1992 and 2006.

This guidance note aims to help policy-makers, HIV programmers, researchers and M&E  practitioners understand what is known about HIV incidence, how they can best interpret and use HIV incidence data and the decisions they can make to promote the appropriate use of HIV incidence data  in the improvement of HIV prevention responses.

As such, this guidance note provides information on:

• the importance of HIV incidence estimations in monitoring the HIV epidemic and HIV prevention responses;
• the different methods used for measuring and estimating HIV incidence, determining trends in incidence and estimating HIV incidence from various data sources;
• the strengths and limitations of different methods for measuring and estimating HIV incidence, as well as how to interpret incidence data;
• ways to expand the use of incidence data as part of the improvement of HIV responses and HIV prevention programmes.
  

This report was researched, written and edited by the Gender Project (Centre for Human Rights) and the AIDS and Human Rights Research Unit (Centre for Human Rights and Centre for the Study of AIDS) at the University of Pretoria. It presents the findings of a desk study undertaken to assess the integration of gender and human rights in HIV-related documents and processes in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe. It highlights best practices, lessons learned, and areas for future action.

This report provides a global update on progress in scaling up priority health sector interventions for HIV prevention, treatment and care in 2008 towards the internationally endorsed goal of universal access.

Other related resources
Executive summary
Fact sheets
Highlights from Eastern and Southern Africa

Thirteen southern and eastern African countries with high HIV prevalence, low levels of male circumcision and heterosexual epidemics have been included in this table.  The information about each country was provided by countries, partners, and UN agencies, mostly from discussions at a sub-regional meeting that took place in Windhoek, Namibia on June 9-10 2009.

A joint Word Bank/UNAIDS report looks at the potential impact of the global financial crisis on HIV prevention and treatment programmes worldwide. Using data collected in March 2009 from 71 countries, the analysis looks at how the crisis could affect the nearly 4 million people living with HIV on treatment, and the 7 million who need treatment but don't have access to it, and proposes some appropriate responses. The potential effects on prevention activities were also investigated. The report suggests that the well-being of millions of people could be put at risk.

The report notes that an important lesson learned during previous crises is that cuts in core social development spending have long-term negative effects. Responding to fiscal pressures by reducing spending on HIV will reverse recent gains and require high-cost offsetting measures over the longer term

A study led by the World Health Organization (WHO) in partnership with the French National  Agency for Research on AIDS and Viral Hepatitis (ANRS), US Centers for Disease Control  and  Prevention  (CDC)  and  Eunice  Kennedy  Shriver  National  Institute  of  Child  Health  and  Human  Development  (NICHD)  of  the  National  Institutes  of  Health,  offers  new  insights  and  new  hope  for  preventing  HIV  infection  and  death  among  infants  in  settings  where  many  mothers  with  HIV  infection  breastfeed,  despite  the  risks.  The  purpose  of  the  study  was  to  assess whether the risk of HIV transmission during breastfeeding could be safely reduced.

This framework provides direction for enhanced action by the UNAIDS Secretariat and UNAIDS Cosponsors on male-to-male sex, transgender issues and HIV. The goal of this framework is to enable UNAIDS to facilitate and support the achievement of universal access to appropriate HIV prevention, care, treatment and support for men who have sex with men and transgender people.

This guidance document results from interactions with civil society in the region and collaboration between UNAIDS, the Harvard AIDS Prevention Research Project and the World Bank, including an expert meeting on MCP held on 28-29 January 2009 in Gabarone, Botswana. It arose from recognition of the need for regional guidance on the principles and good practice for MCP campaigning to assist national programmes, in particular, to strengthen HIV prevention efforts for MCP reduction.

This UNAIDS report estimates that an investment of US$ 25 billion will be required for the global AIDS response in 2010 for low- and middle-income countries-US$ 11.3 billion more than is available today.

The investment needs is based on the country-defined targets to reach universal access to HIV prevention, treatment care and support by 2010. The new report anticipates that nearly one third of this investment will come from domestic sources, with investments from multilateral and bilateral sources needed for the remaining US$ 17 billion.

The report highlights that, of the total investments required, approximately one third is for activities addressing behavioural change, social drivers of the epidemic, social mitigation and other services that are managed outside of the health sector through multisectoral programmes.

The UNAIDS Inter-Agency Task Team (IATT) on HIV and Young People support an accelerated, harmonized and expanded global, regional and country-level response to increase young people's utilization of HIV prevention, treatment, and care services.

A series of seven Guidance Briefs has been developed by the task team. They aim to help decision makers (including development practitioners, governments donors and civil society organizations) understand what needs to be done, based on the latest global evidence on effective interventions for young people. The following Briefs are available at http://www.unfpa.org/hiv/iatt/

• Overview of HIV Interventions for Young People

• HIV Interventions for Most-at-risk Young People

• HIV Interventions for Young People in Humanitarian Emergencies

• Community-based HIV interventions for Young People

• HIV Interventions for Young People in the Education Sector

• HIV Interventions for Young People in the Health Sector

• HIV Interventions for Young People in the Workplace

The Joint Learning Initiative on Children and HIV/AIDS seeks to provide an independent, collaborative analysis of what is working, and what needs to change in the global response to children affected by HIV/AIDS. Learning Group membership is composed of practitioners, scholars, policymakers and other experts, and incorporates gender and geographical balance, disciplinary diversity, and strong representation from countries with a high burden of HIV/AIDS.

The Initiative's final work product-expected in late 2008-will be policy and programme recommendations based on the work of the Learning Groups.

Core Research Areas

Strengthening Families

Examines the HIV pandemic's impact on family and social support systems, and investigates how families can best be supported to protect children and adolescents from HIV infection, poverty and social disruption.

Community Action

Looks at how community-based responses to children affected by HIV/AIDS can be made more effective and cost-efficient, while preserving and strengthening local empowerment.

Access to Service & Human Rights

Identifies ways to overcome barriers to providing essential, integrated health care and social services for children in low-income, high disease burden communities.

Social & Economic Policies

Documents the policy changes and new resources needed to help governments and international institutions effectively protect children-particularly adolescent girls-affected by HIV/AIDS. This group will also identify costs for the policy and programming recommendations of the other Learning Groups.

For more information and to access these Final Learning Group Synthesis Papers, visit JLICA's website www.jlica.org

AIDS and climate change (CC) are two of the most important "long wave" global issues of the recent past, the present and the future. They share similarities, interactions, and present possibilities for a more united response. Yet these links have received little analysis.

This paper seeks to address that gap. It first focuses on scientific issues, identifying major, minor, and speculative pathways by which AIDS and CC are likely to interact. These interactions are, here, called the HIV and Climate Change Complex (HACC).

The maximum impact of CC is in the future, likely to occur decades after the peak incidence of HIV. The severity of the HACC will largely be determined by the temporal overlap of these ranges. The HACC will also have an uneven spatial distribution, modified by the regional impact of CC and the regional epidemiology of AIDS, each of which varies by physical and social elements.

Populations with currently high rates of HIV are the most vulnerable to a worsening or prolongation of the epidemic due to CC. This places the people of SSA at the greatest risk of the HACC, though outside Africa populations in north east India and New Guinea may also be significantly impacted.

This Stocktaking Report, the third since the Unite for Children, Unite against AIDS initiative was launched in 2005, examines data on progress, emerging evidence, and current knowledge and practice for children as they relate to four programme areas known as the 'Four Ps': preventing mother-to-child transmission of HIV, providing paediatric HIV care and treatment, preventing infection among adolescents and young people, and protecting and supporting children affected by HIV and AIDS.

From June 2007 to July 2008 UNAIDS and GAMET led a five-country Modes of Transmission (MoT) process. A process evaluation was undertaken of the process, and an impact evaluation is planned at a later stage, once countries have disseminated the results of the study.

Male circumcision is an important intervention that is increasingly being incorporated into national HIV prevention programmes - especially in settings where HIV prevalence is high and the prevalence of circumcision is low. Effective communications is a vital component of any scale-up strategy.

This document offers guidance to programme managers and policy-makers on how to plan and manage communications to support the scale-up of male circumcision in Eastern and Southern Africa.
A number of key issues require strong communications support to ensure clarity about the relationship between male circumcision and HIV prevention.