Criminalization of same-sex sexual relations, sex work, drug possession and use, and HIV exposure, non-disclosure and transmission have been shown to block HIV service access and increase HIV risk.

Countries that criminalize key populations saw less progress towards HIV testing and treatment targets over the past five years—with significantly lower percentages of people living with HIV knowing their HIV status and achieving viral suppression than in countries that avoided criminalization. Even greater gains were achieved in countries where laws have advanced human rights protections, particularly those that protected rights to non-discrimination and responded to gender-based violence. Despite this compelling evidence, discriminatory and punitive laws remain alarmingly common.

Marcia John (not her real name), a Guyanese transgender woman, readied to leave a transgender support group meeting. She slipped off her black wig, replacing it with a bandana and hat. Her employer only allows her to perform her duties if she presents as a man.

“I have no choice,” she said. “I have to work.”

In 2018, the Caribbean Court of Justice ruled that an 1893 Guyana law that prohibited cross-dressing was unconstitutional. Last August, lawmakers formally removed that section from the law books. But for Ms John and other transgender women, this has not been enough to transform the way they navigate social spaces. Intolerant attitudes remain, with sometimes dire implications for transgender people’s welfare and livelihoods.

Led by the University of the West Indies Rights Advocacy Project, the cross-dressing law challenge started with a constitutional action filed in the Guyana High Court in 2010. Eight years and two appeals later, the litigants earned a historic win.

“At the heart of the right to equality and non-discrimination lies a recognition that a fundamental goal of any constitutional democracy is to develop a society in which all citizens are respected and regarded as equal,” the Caribbean’s final appellate court ruled in 2018.

Reflecting on the impact of the landmark law reform effort, Alessandra Hereman, Guyana Trans United (GTU) Project Coordinator, said that the main benefit has been more visibility.

“The community’s increased media presence in the lead-up to the case brought transgender issues into the public space. People realized that transgender Guyanese exist and are part of our society. Some thought we should be treated equally and others held on to their religious beliefs. But transgender issues were brought to the fore and were part of public discourse,” she said from GTU’s Georgetown office.

Formed in 2012, GTU has worked over the past decade to facilitate the dialogue and sensitization that are needed alongside key law and policy reforms to create a safe and empowering social context for transgender people. They contribute to the ongoing effort to shift the attitudes and perceptions of health-care providers around sexual orientation and gender identity. This work strengthens the community’s access to health services, including HIV prevention, testing and treatment. With support from UNAIDS, GTU also trained journalists on covering transgender people and issues ethically and accurately.

“Law reform is essential, but it is not a stand-alone,” said James Guwani, the Director of the UNAIDS Caribbean Sub-Regional Office. “Alongside strategies like judicial review and political advocacy, there must be ongoing community dialogue and targeted efforts to increase social inclusion.”

At present, GTU has two high law and policy reform priorities. First, Guyana’s Prevention of Discrimination Act of 1997 makes no mention of sexual orientation or gender identity.

“Employers use the lack of this protected status to discriminate against lesbian, gay, bisexual and transgender (LGBT) persons. Amending that legislation would mean that if you violate the rights of an LGBT person there would be some mechanism for redress. Having that in place will tell people you can’t discriminate because there will be consequences,” Ms Hereman explained.

The CARICOM Secretariat, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), has developed a model anti-discrimination bill to guide Caribbean countries in creating anti-discrimination laws. PANCAP continues to advocate with regional stakeholders, including policymakers, for countries to adopt the model as it provides for the protection of persons against discrimination, including discrimination involving harassment, victimisation and vilification on the grounds of HIV status, sexual orientation, etc. It is hoped that the model will lead to more access to health care for key populations with the overarching goal of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected. Next on GTU’s list is the revision of the Teachers’ Code of Conduct to be inclusive of the needs of LGBT students.

“They must know that they have a duty to create an enabling environment for all students so that LGBT pupils have an opportunity to learn without bullying,” Ms Hereman said.

Lack of gender recognition legislation and the criminalization of sex between people of the same sex remain challenges in the Guyana and wider Caribbean contexts. The United Caribbean Trans Network has mounted a campaign around gender identity recognition, while the Society against Sexual Orientation Discrimination is working to remove Sections 351 to 353 of the Criminal Law (Offences) Act, which make sex between men punishable with life imprisonment. However, GTU is first prioritizing issues that it says go to the heart of transgender’s people’s ability to get an education and access employment. Exclusion from these spaces compounds their vulnerability to poverty, violence and disease.

“We occupy the lowest socioeconomic level in society. Guyana is now an oil-producing nation. LGBT people should have opportunities as well,” Ms Hereman insisted.

Discriminatory experiences within health-care settings can be especially common and pernicious. Country data reported to UNAIDS show that the proportions of people belonging to key populations who avoid health-care services due to stigma and/or discrimination remain disconcertingly high. Across all key populations, at least one in three reporting countries stated that more than 10% of respondents avoided health care, including three in four countries for people who inject drugs.

Removing laws that harm, such as laws on sex work, same-sex sexual relations, the use or possession of drugs for personal use and the non-disclosure, exposure or transmission of HIV, is one way of overcoming stigma and discrimination and hence increasing the uptake of services by key populations.

Sexual activity often starts during adolescence. Many countries have age of consent laws in relation to sexual activity that are inconsistent with minimum age laws for accessing sexual and reproductive health information and services without parental permission. This means that adolescents may legally have sex before they can legally access any information or services relating to safer sex practices or contraception, leaving them at greater risk of HIV, other sexually transmitted infections (STIs) and unwanted pregnancy.

The removal of laws that require parental permission to access services for sexual and reproductive health and HIV prevention, testing and treatment has been shown to improve health-seeking behaviours. That effect is even stronger when schools can provide age-appropriate comprehensive sexuality education to young people so they can protect themselves from HIV, STIs, unwanted pregnancy and gender-based and sexual violence.

Forty countries reported to UNAIDS in 2021 that they have laws requiring parental/guardian consent for adolescents to access hormonal or long-lasting contraceptives, 108 reported that this consent is required for an HIV test, 43 for HIV self-testing, 92 for HIV treatment and 22 for PrEP. Among these countries, some provide exceptions based on demonstrated maturity: 10 for hormonal or long-lasting contraceptives, 15 for HIV testing, eight for self-testing and nine for HIV treatment. The age cut-off of parental consent laws varied by service. The majority of countries that reported having requirements for parental/guardian consent had an age cut-off of 18 years, with exceptions in a few countries where adolescents as young as 14 years could access a service without parental/guardian consent, which varied by service. 

Members of parliament have reaffirmed their commitment to tackle all forms of HIV-related stigma and discrimination in Jamaica and to help enhance efforts to create an enabling environment for people living with and affected by HIV.

At a meeting co-hosted by UNAIDS and Juliet Cuthbert-Flynn, the Minister of State for Health and Wellness and Chair of the country’s Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, members of parliament, from both the ruling and opposition parties, came together to review evidence on stigma and discrimination in Jamaica and its impact on health outcomes and to craft a way forward in which their role as lawmakers can contribute to eliminating stigma, discrimination and violence.

Jamaica’s legal landscape poses substantial barriers for people living with and affected by HIV to access health services. For example, same-sex sexual relations are criminalized in Jamaica, which continues to represent a considerable deterrent for marginalized communities. Moreover, the country lacks general legislation against discrimination, a national human rights institute and a gender recognition law that could provide further protection for transgender and gender non-conforming people in Jamaica.

Harmful laws, policies and generalized stigma and discrimination against people living with and affected by HIV have a profound negative effect on people’s health outcomes and life prospects. The most recent Knowledge, Attitudes, Practices and Behaviour Survey and the People Living with HIV Stigma Index showed that only approximately 12% of the general population have accepting attitudes towards people living with HIV, while close to 60% of people living with HIV have feelings of self-stigma. A 2019 study about the economic survivability of transgender and gender non-conforming communities in Jamaica found  that experiences of workplace stigma and discrimination were widespread, with about 60% of survey respondents declaring such incidents. Furthermore, 71% of respondents felt that transgender and gender non-conforming people had a harder time getting jobs than cisgender people. Another study suggests that approximately 20% of lesbian, gay, bisexual and transgender people in Jamaica have been homeless at some point of their lives.

In view of these pending challenges in the country’s HIV and human rights response, members of parliament explored creating a working group tasked with performing periodic reviews of relevant data, supporting the enactment of protective legislation, challenging harmful laws and policies and hosting permanent dialogues with communities of people living with and affected by HIV.

“We have a lot of work to do to ensure that all Jamaicans enjoy the full respect, protection and promotion of their rights. This meeting and its outcomes are a small step to achieving that goal, but a step that certainly is pointing us to the right direction on the role that members of parliament should play to end discrimination,” said Ms Cuthbert-Flynn.

These efforts, which aim to tackle deeply rooted misconceptions in society, require strong partnerships. As stated by Morais Guy, the Opposition Spokesperson on Health, who co-chaired the meeting, “The enhancement of people’s rights and collective efforts to ensure that every Jamaican can live a life free from stigma, discrimination and violence is not an issue of only one person, one entity or one political party. It is the business of all of us, to work in partnership for the dignity of all Jamaicans.” 

Members of parliament also discussed some of the challenges that they face as legislators to perform their duties, and the contributions that UNAIDS can make in facilitating a more efficient, effective and transparent law-making process in parliament. Moreover, options to mobilize and engage citizens at the community level to challenge stigma were also discussed in response to the critical need of raising more awareness, tolerance and respect towards people living with and affected by HIV.

“We are proud to partner with members of parliament to tackle stigma and discrimination in Jamaica and to provide all of the evidence, instruments and support that we can mobilize to leverage their role as allies and critical influencers in the future of the country,” said Manoela Manova, the UNAIDS Country Director for Jamaica. 

GENEVA, 19 November 2021—Having experienced major shortfalls in funding since 2015, UNAIDS convened donors, partners and Programme Coordinating Board members in Geneva, Switzerland, for a dialogue to help bolster UNAIDS’ efforts in supporting countries to end AIDS by 2030 as part of the Sustainable Development Goals.

During the meeting, held on 15 November 2021, UNAIDS warned that despite a growing number of countries demonstrating the feasibility of ending AIDS as a public health threat, the global HIV response is faltering, resulting in a slowing decline in new HIV infections and AIDS-related deaths. Around 1.5 million people became newly infected with HIV in 2020, and every 60 seconds someone died of an AIDS-related illness. Without an immediate course correction and renewed momentum, UNAIDS fears that hopes for reaching the 2030 target of ending AIDS could vanish.

“As we move into the next phase of the AIDS response, the risk of political neglect increases as the epidemic concentrates among the most marginalized, discriminated against and criminalized—key populations and adolescent girls and young women,” said Winnie Byanyima, Executive Director of UNAIDS. “The Joint Programme is needed now more than ever.”

The meeting was held to deepen the understanding of the work of UNAIDS and its critical role in global health. Speakers highlighted that since its inception in 1996, UNAIDS has brought unique value to the global AIDS response, leveraging the combined strengths of the United Nations system, leading efforts to expand access to HIV prevention, treatment and care services, increasing global resources for HIV, building political commitment and collecting data to build evidence-informed responses.

The Chair of the UNAIDS Programme Coordinating Board demonstrated how UNAIDS’ support has adapted to and been critical in the COVID-19 crisis. “In Namibia, we have seen very clearly the contribution of UNAIDS during this very difficult past year as we experienced an exponential increase in COVID-19 cases, hospitalizations and deaths,” said Julia Imene-Chanduru, representing the Chair of the UNAIDS Programme Coordinating Board. “Our health system was severely overstretched. During this time, UNAIDS supported Namibia to ensure the continuity of treatment for people living with HIV by supporting us to move to multimonth dispensing of antiretroviral treatment and assisting us in strengthening community engagement for COVID-19 and HIV.”

Speakers emphasized that UNAIDS has also been instrumental in tackling stigma and discrimination and fighting for equality and human rights. Overall, these unique, essential contributions from UNAIDS account for less than 1% of all funding available for HIV activities in low- and middle-income countries.

“Our health is a bedrock not only for life itself, but it is essential to achieving the Sustainable Development Goals,” said Amina Mohammed, Deputy Secretary-General of the United Nations. “UNAIDS is smart and brings transformative action to life. Of the total global funding for HIV, the 1% that UNAIDS represents helps leverage billions more. I urge you to continue to increase your contributions to this organization and support its incredible life-saving work.”

Since 2015, UNAIDS has experienced severe shortfalls in funding. For 2020 and 2021, UNAIDS had an approved annual budget of US$ 242 million. In 2020, UNAIDS raised US$ 194.1 million, but is expected to raise only US$ 165 million in 2021. The meeting provided an opportunity to deepen the understanding of donors of the work of UNAIDS and warned of the cost of inaction or insufficient funding.

“Our current funding situation limits what is possible and what can be made possible,” said Ms Byanyima. “It is time to invest. It is time to match our political ambition and equip all our stakeholders to drive the response forward and help realize the human right to health for all.”

“It is our responsibility as the Joint Programme to put AIDS back on the development agenda. But not only with the speeches but also with budgets. The call of the nongovernmental organization delegation is that we want a fully funded UBRAF. We want a fully funded UNAIDS and fully funded AIDS response,” said Gracia Violeta Ross Quiroga, National Chair of the Bolivian Network of People Living with HIV/AIDS (REDBOL).

UNAIDS urges donors and partners to create momentum around potential opportunities and mutual commitments relating to funding UNAIDS and the AIDS response, including prioritizing resource allocation and priority-setting. UNAIDS urges donors to ensure adequate, predictable and flexible funding for UNAIDS through multi-year agreements for core and non-core funding to fully support UNAIDS’ efforts to end AIDS by 2030.

“We reiterate calls that have been made today by the Secretariat and Cosponsors for funding to be predictable and sustained in order to enable the Joint Programme to deliver on our common goals. Kenya remains committed to supporting this process and stands ready to engage in any subsequent discussions,” said Peace Mutuma, Health Attaché, Permanent Mission of Kenya to the United Nations in Geneva.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Inequalities and human rights barriers, which have been magnified by the COVID-19 pandemic, are preventing progress towards ending AIDS as a global public health threat by 2030. They facilitate the transmission of HIV by increasing vulnerability to HIV and limiting access to health services, particularly for gay men and other men who have sex with men, transgender people, people who use drugs, sex workers, women and girls.

Ending inequalities is both a human rights imperative and a public health necessity. Yet, despite repeated commitments, human rights barriers that drive inequalities, such as stigma, discrimination, violence and punitive laws, continue to undermine the HIV response. 

To highlight the critical need for progress on human rights barriers, and to call on all stakeholders to play their part to increase action, UNAIDS convened civil society partners, United Nations Member States, jurists and development organizations on the sidelines of the United Nations High-Level Meeting on AIDS in New York. At the event, From Promises to Action: Scaling Up Efforts against Human Rights Barriers, including HIV-Related Stigma and Discrimination, which took place on 9 June, the panellists emphasized the critical need to generate long-term investment and transformative action on human rights and stigma and discrimination, particularly on discriminatory criminal laws, in order to change structural and social barriers and, ultimately, reduce inequalities. 

The panellists exchanged best practices, discussed how human rights-based and gender-transformative approaches could reduce inequalities and issued a call for a rapid scale-up of funding, commitment and action in this area to reach the people most left behind.

The event served as a reminder that 62% of new HIV infections in 2019 were among key populations, who are still criminalized in many countries, and their sexual partners, that due to gender inequality and harmful gender norms, AIDS is still one of the leading causes of death among adolescent girls and young women in sub-Saharan Africa and six out of seven new HIV infections among adolescents (aged 15 to 19 years) in the same region are among girls.

The event also provided hope that action and change is possible. During the event, the Governments of Angola, Costa Rica and the Gambia announced that they are joining the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination.

At the event, Winnie Byanyima, the UNAIDS Executive Director, called on the international community to rally behind the bold new targets and commitments laid out in the Global AIDS Strategy 2021–2026. She highlighted that the strategy was a crucial development, as it set for the first time specific targets to reduce the societal enablers driving inequality, giving them the same priority and commitment as biomedical interventions.  

Having new targets means that there is a need for new tools and guidance, and Ms Byanyima unveiled a new series of human rights fact sheets to support action by all stakeholders on removing human rights barriers, such as criminal laws, stigma and discrimination. The series is available in multiple languages: in addition to English, French, Russian and Spanish (follow the language menu on the top right), it's also available in Portuguese (1, 2, 3, 4, 5, 6, 7).

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The President of Senegal, Macky Sall, pledges an additional $3.5 million to support the HIV response and the call for action

DAKAR/GENEVA, 3 November 2021—A three-day regional summit on HIV/AIDS held in Dakar, Senegal, has concluded with a call to action that urges stronger support for community-led responses, policies driven by science and data, increased investment in the HIV response and putting HIV at the centre of pandemic preparedness and response. In his closing remarks, the President of Senegal, Macky Sall, committed to advancing the call to action with the African Union and pledged additional funds to implement it in Senegal and across the region. 

Western and Central Africa is home to 4.7 million people living with HIV—12% of those living with HIV globally—but experiences 22% of all HIV deaths in the world. Countries in the region, on average, have seen slower declines in HIV infections than other countries on the continent and HIV prevalence in women is significantly higher than in men. Access to HIV testing and treatment reached 73% of people living with HIV in 2020, up from 38% in 2015, but short of the 81% goal that was set for 2020. The region has the world’s highest number of HIV-positive pregnant women still waiting for treatment, and just 24% of children living with HIV were virally suppressed.

The Dakar Call to Reinvent the Response to the HIV Pandemic calls for urgent action in four main areas:  

1. Expand community-led infrastructure and organizations to strengthen national systems for health and shift policies to enable sustained funding for community organizations. Too many of the most vulnerable people in Western and Central Africa region do not have access to conventional health systems. Evidence shows community-led organizations and networks are critical to filling the gaps. This includes expanding the provision of HIV treatment and prevention services by community-led organizations in partnership with the public health system, ensuring that organized civil society and affected communities are included as key partners in decision-making bodies, and building accountability structures such as community-led monitoring.

2. Update health policies to align with the latest HIV science and evidence. Countries that have aligned their HIV policies and programmes with the current science have made greater progress against HIV/AIDS. Governments are urged to review their health policies in consideration of the latest scientific data and evidence. This is as a key step to improve the HIV response, and particularly to address the needs of those most vulnerable to HIV.

3. Increase national and international resources for HIV in the region by 33% by 2025 and remove financial barriers to access health services by people living with HIV. UNAIDS studies show that $2.67 billion by 2025, representing a 33% increase, would ensure sufficient funding for a comprehensive response to HIV in the region. Insufficient progress in the response to the HIV pandemic is only increasing the long-term costs that will strain already overburdened health budgets.

4. Put HIV and COVID-19 at the centre of pandemic preparedness and response. Many of the measures needed to accelerate the HIV response will also help prevent future pandemics.  These measures include strengthening and protecting the formal and informal health workforce, collecting quality epidemic data to inform decision-making, implementing rights-based responses, and ensuring equitable access to new medical technologies.

These four actions are achievable in the next three years and would move the region closer to the 2025 global target of 95% of people knowing their HIV status; 95% of people who know their HIV status initiating treatment; 95% of people on treatment being virally suppressed. They would contribute to a dramatic reduction in the number of AIDS-related deaths and new HIV infections in the region.

Western and Central Africa has been at the forefront of some of the most innovative and successful efforts in the global response to HIV. Ending the AIDS epidemic as part of the 2030 Sustainable Development Agenda remains a priority even though the region faces multiple challenges including the response to the COVID-19 pandemic, numerous economic and security crises, and climate change.  

During the summit governments, civil society actors, community-led organizations, scientists, and other partners reviewed new data and progress against HIV in the last 5 years and took note of the new UNAIDS Global AIDS Strategy 2021-2026 and the United Nations General Assembly Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030. The summit was co-organized by UNAIDS and the Civil Society Institute of HIV and Health in Western and Central Africa and hosted by the President of Senegal, Macky Sall. It was held with the support of Luxembourg and the Bill and Melinda Gates Foundation.

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UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Leaders from governments, civil society and the United Nations have renewed their commitment to make urgent and strategic investments in adolescent girls’ and young women’s rights, education and health. At  a three-day regional summit on HIV/AIDS held in Dakar, Senegal that concluded with a call to action, the Education Plus initiative was applauded as a timely intervention to address the high number of adolescent girls and young women acquiring HIV in the Western and Central Africa region.

The Education Plus Initiative, a high-level political advocacy drive to accelerate actions and investments to prevent HIV, was launched as a joint commitment of UNAIDS, UNESCO, UNFPA, UNICEF and UN Women at the Generation Equality Forum in July this year. The Education Plus initiative is centred on the empowerment of adolescent girls and young women and the achievement of gender equality in sub-Saharan Africa—with secondary education as the strategic entry point for providing the multi-sectoral plus package.  The initiative calls for free and quality secondary education for all girls and boys in sub-Saharan Africa by 2025; universal access to comprehensive sexuality education; fulfilment of sexual and reproductive health and rights; freedom from gender-based and sexual violence; school-to-work transitions, and economic security and empowerment.  

While the Western and Central Africa region has progressed in girls’ education over the last two decades, the UNICEF 2019 report found that “the region still has the highest gender gaps in education in the world”. One in four adolescent girls aged 15-19 who have ever been married or in union, has experienced emotional, physical, or sexual violence at the hands of a husband or partner.

HIV/AIDS remains a major public health threat in the Western and Central Africa where 4.7 million people are living with HIV—12% of those living with HIV globally—but experiences 22% of all AIDS deaths in the world. Adolescent girls and young women (aged 15-24) in West and Central Africa are twice as likely to acquire HIV than their male peers.  Five in six new HIV infections (82% / 18,237 females) among adolescents 15-19 years are among females. Three-quarters (74%) of new HIV infections in the age group 15-24 in the region are in females (40,432 females / 13,860 males). Every week, approximately 800 adolescent girls and young women in WCA are newly infected with HIV. 

Secondary education offers protection to adolescent girls and young women from HIV—with reductions in HIV incidence among girls who complete secondary education by as much as one-third to one half in some countries.

However, most countries in Western and Central Africa are falling short of meeting the target of allocating 20 percent of government resources to education as required under the African Union’s Dakar Commitment on Education for All. Before the COVID19 pandemic, only Burkina Faso, São Tome and Principe, Senegal, Sierra Leone and Togo allocated at least 20 percent of their national budgets to education. As a percentage of GDP, education spending varies from 1.1 percent in Central African Republic to 7.7 percent in Sierra Leone.

Before COVID-19 struck, around 34 million secondary school-aged girls in sub-Saharan Africa were being denied a full 12-years of education and an estimated 24% of adolescent girls and young women (15–24 years) in the region were not in education, training or employed, compared to 14.6% of young men.  UNICEF estimates that in 2020 school closures due to COVID-19 impacted around 250 million students in the sub-Saharan Africa region, millions of whom may never return to the classroom-especially girls.

To date, five countries—Benin, Cameroon, Gabon, Lesotho and Sierra Leone—have signed on to champion the initiative with a wide range of commitments that will tackle the urgency of effectively addressing the alarming numbers of adolescent girls and young women acquiring HIV and dying from AIDS-related illnesses, among other threats to their survival, well-being, human rights and freedoms, including sexual and gender-based violence and teenage pregnancy. 

The Education Plus initiative is committed to advancing young women’s leadership as key to ending AIDS as a public health threat and in rebuilding communities and countries during and post pandemic.

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During the West and Central Africa Summit on HIV in Dakar, several international partners and ministers gathered to discuss the pressing situation around health financing in the region, exacerbated by the economic crisis due to COVID-19. When it comes to funding HIV responses, WCA is facing a perfect storm: resources available for HIV in the region in 2020 were approximately three quarters of the amount needed. In addition, total HIV resources in the region declined by 11% in the last decade. While PEPFAR and the Global Fund have increased their commitments to the region, domestic resources have slowed down since 2018 and dropped dramatically in 2020.

COVID-19 epidemic did not help. Most African governments have responded to the economic shock by increasing government spending last year however, but with revenues hit by the slow-down, the pandemic will leave many countries with large deficits and unmanageable debts.

Winnie Byanyima, UNAIDS Executive Director, stressed the importance of focusing on these challenges by also re-thinking and reforming overall health systems. She urged countries, as did many other panellists, to use dwindling funds more efficiently, and to ensure additional resources be dedicated to health. “Healthy people means healthy economies,” she said.  She also called for more space to be given urgently to community-led services.

“We need to properly fund community infrastructure and response to be strongly integrated with formal health systems. This is critical as we think about preparing and coping with future pandemics,” Ms Byanyima said.

PEPFAR Deputy Coordinator for Multi-Sector Relations Mamadi Yilla wholeheartedly agreed. "COVID-19 acted like a catalyst and everyone recognized civil society’s role in getting services to the people,” she said. Mentioning that PEPFAR has invested billions in Africa since 2003, she said that the partnerships have to be re-invented and urged governments to work hand in hand with civil society as well as deploy funds in a targeted fashion.

“We have to challenge ourselves to make each dollar count,” said Global Fund Executive Director Peter Sands, "COVID-19 has indeed highlighted the obvious: investing in health makes sense.” He added, “It is important to have finance and economic ministers as part of the answer because health ministers will not be able to solve this on their own.”

Recognizing the need for increased domestic spending on health, the Senegalese Minister of Economy, Planning and Cooperation, Amadou Hott, noted that the current economic slump limits countries' ability to invest more of their resources in the sector. He, like Ms Byanyima, said additional resources must be drawn from debt cancellation, additional international financing mechanisms such as augmenting international liquidity (Special Drawing Rights (SDRS) from the IMF), and fight tax evasion to help increase domestic tax collection.

The Sierra Leone Health Minister, Austin Demby, said that earmarking disease specific resources does not build sustainable health systems, citing an example of a recent measles outbreak in his country. He had to immediately deploy funds to contain it. “We have to create broader platforms to be more flexible,” he said. “Make sure some of the systems around community engagement, and services used every day for HIV, tuberculosis, and malaria can be used for other diseases.”

In addition, financing shouldn’t be tied to specific implementing partners. Both Ministers stressed that to transform health systems, they needed to be given more leeway to implement models that can be self-sustaining on domestic resources, which was not currently the case.

Finally, climate change must be taken into account as it impacts the planet and inevitably people’s wellbeing. The West and Central Africa region, hit hard by desertification and drought, will only feel more pressure on already overwrought health systems.

“Linking funding for climate change and health is crucial because one will inevitably impact the other and increase vulnerabilities to pandemics and diseases,” Mr Hott said in his closing remarks.