UNAIDS urges world leaders to adopt a bold political declaration on HIV at the United Nations General Assembly High-Level Meeting on AIDS, being held in New York and online next week, and to commit to achieving a new set of targets for 2025 to end AIDS by 2030

NEW YORK/GENEVA, 3 June 2021—Four decades after the first cases of AIDS were reported, new data from UNAIDS show that dozens of countries achieved or exceed the 2020 targets set by the United Nations General Assembly in 2016—evidence that the targets were not just aspirational but achievable.

The report shows that countries with progressive laws and policies and strong and inclusive health systems have had the best outcomes against HIV. In those countries, people living with and affected by HIV are more likely to have access to effective HIV services, including HIV testing, pre-exposure prophylaxis (medicine to prevent HIV), harm reduction, multimonth supplies of HIV treatment and consistent, quality follow-up and care.

“High-performing countries have provided paths for others to follow,” said Winnie Byanyima, the Executive Director of UNAIDS. “Their adequate funding, genuine community engagement, rights-based and multisectoral approaches and the use of scientific evidence to guide focused strategies have reversed their epidemics and saved lives. These elements are invaluable for pandemic preparedness and responses against HIV, COVID-19 and many other diseases.”  

Globally, the report shows that the number of people on treatment has more than tripled since 2010. In 2020, 27.4 million of the 37.6 million people living with HIV were on treatment, up from just 7.8 million in 2010. The roll-out of affordable, quality treatment is estimated to have averted 16.2 million deaths since 2001.

Deaths have fallen in large part due to the roll-out of antiretroviral therapy. AIDS-related deaths have fallen by 43% since 2010, to 690 000 in 2020. Progress in reducing new HIV infections has also been made, but has been markedly slower—a 30% reduction since 2010, with 1.5 million people newly infected with the virus in 2020 compared to 2.1 million in 2010.

The report underscores that countries with punitive laws and that do not take a rights-based approach to health punish, ignore, stigmatize and leave key populations—which make up 62% of new HIV infections worldwide—on the margins and out of reach of HIV services. For example, almost 70 countries worldwide criminalize same-sex sexual relationships. Gay men and other men who have sex with men, sex workers, transgender people, people in prison and people who inject drugs are left with little or no access to health or social services, allowing HIV to spread among the most vulnerable in society.

Young women in sub-Saharan Africa also continue to be left behind. Six out of seven new HIV infections among adolescents aged 15–19 years in the region are among girls. AIDS-related illnesses remain the leading cause of death among women aged 15–49 years in sub-Saharan Africa.

COVID-19 has shown the fragility of the health and development gains made over the past decades and has exposed glaring inequalities. To get the world on track to end AIDS by 2030, the global AIDS community and UNAIDS have used an inequalities lens to develop an ambitious and achievable strategy with new targets to reach by 2025. Ending inequalities requires HIV responses that can reach the populations currently being left behind.

If reached, the targets will bring HIV services to 95% of the people who need them, reduce annual HIV infections to fewer than 370 000 and AIDS-related deaths to fewer than 250 000 by 2025. This will require an investment of US$ 29 billion a year by 2025. Each additional US$ 1 of investment in implementing the global AIDS strategy will bring a return of more than US$ 7 in health benefits.

UNAIDS urges the United Nations General Assembly to commit to the targets in a new political declaration on HIV at the fifth United Nations General Assembly High-Level Meeting on AIDS, taking place from 8 to 10 June 2021.

“The world cannot afford to underinvest in pandemic preparedness and responses,” said Ms Byanyima. “I strongly urge the United Nations General Assembly to seize the moment and commit to taking the actions needed to end AIDS.”

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.

Forty years since the first AIDS cases were reported and just weeks before the United Nations General Assembly High-Level Meeting on AIDS, the United Nations Secretary-General has released a new report with recommendations and targets to get the world back on track to end AIDS

NEW YORK, 30 April 2021—The United Nations Secretary-General, António Guterres, has warned that despite intensive action and progress made against HIV in some places and population groups, HIV epidemics continue to expand in others and issued a set of 10 key recommendations.* If followed by all countries, this will end the AIDS pandemic as a public health threat by 2030 as part of the Sustainable Development Goals. In a new report, Addressing inequalities and getting back on track to end AIDS by 2030, the United Nations Secretary-General urges the world to address the inequalities that are slowing progress. 

“It is imperative to break out of an increasingly costly and unsustainable cycle of achieving some progress against HIV but ultimately not enough to bring about an end to the pandemic,” said Mr Guterres in the report. “Inequalities are the key reason why the 2020 global targets were missed. By ending inequalities, transformative outcomes can be achieved for people living with HIV, communities and countries.”

The global targets set out in the General Assembly’s 2016 Political Declaration on Ending AIDS were missed by a long way, allowing the AIDS pandemic to grow in many regions and countries. The staggering 1.7 million new HIV infections that occurred in 2019 are more than three times higher than the 2020 target of less than 500 000 new infections. In addition, the 690 000 AIDS-related deaths in 2019 far exceed the 2020 target of reducing deaths to fewer than 500 000 a year.

“Ending AIDS as a public health threat by 2030 is still within reach—many countries are showing that rapid progress against HIV is possible when evidence-informed strategies and human rights-based approaches are adopted,” said UNAIDS Executive Director Winnie Byanyima. “But it requires bold political leadership to challenge and address the social injustices and inequalities that continue to make certain groups of people and entire communities highly vulnerable to HIV infection.”

The report notes that COVID-19 has caused additional setbacks. The United Nations Secretary-General warned that COVID-19 is not an excuse for missing AIDS targets, but rather a stark warning to the countries that they can no longer afford to underinvest in pandemic preparedness and responses.

At the same time, the COVID-19 pandemic has underscored the many spill-over benefits of HIV investments in health and development. Community-led service delivery pioneered by the HIV response is helping to overcome the extraordinary impediments created by COVID-19.

The set of 10 recommendations to get the world back on track include: addressing inequalities and reaching all people living with or at risk of HIV infection to reduce the annual new HIV infections to under 370 000 and annual AIDS-related deaths to under 250 000 by 2025; prioritizing HIV prevention to ensure that 95% of people at risk of HIV infection have access to effective HIV prevention options by 2025; and eliminating new HIV infections among children.

The report underscores that addressing social and structural factors that perpetuate inequalities is key. It highlights, for example, how gender inequality, underpinned by harmful gender norms, restricts women’s use of HIV and sexual and reproductive health services by perpetuating gender-based violence and limiting decision-making power, including the ability of women and girls to refuse unwanted sex, negotiate safer sex and mitigate HIV risk.

It also shows how vulnerable, marginalized and criminalized communities, such as gay men and other men who have sex with men, people who use drugs, sex workers, transgender people, prisoners and migrants, also remain at higher risk of HIV infection than the general population because they are not receiving essential information and HIV treatment, prevention and care services.

The United Nations Secretary-General describes how communities of people living with, at risk of and affected by HIV are the backbone of the HIV response. Initiatives led by people living with HIV, women, key populations, young people and other affected communities have identified and addressed key inequalities and service gaps, advocated for the rights of their constituents and expanded the reach, scale and quality of health services.

In the report, Mr Guterres applauds UNAIDS’ recently adopted Global AIDS Strategy 2021–2026: End Inequalities, End AIDS. “The lessons from the countries, cities and communities that successfully fast-tracked their HIV responses over the last five years are at the heart of the UNAIDS Global AIDS Strategy 2021–2026,” said Mr Guterres. “The global AIDS community and UNAIDS have used an inequalities lens to develop the strategy, with new targets that are ambitious, granular and tailored to reach the furthest behind first.”

The report comes 25 years after the creation of UNAIDS and describes how COVID-19 has exposed social inequalities and health system weaknesses. The United Nations Secretary-General says that the world should leverage the experience from responding to the AIDS pandemic to strengthen health systems across the world and improve pandemic preparedness. He also calls for enhanced global solidarity to close the HIV resource gap and increase annual HIV investments in low- and middle-income countries to US$ 29 billion by 2025. 

*The 10 recommendations in the United Nations Secretary-General’s report:

1.      Reduce and end the acute and intersecting inequalities that are obstructing progress to end AIDS.
2.      Prioritize HIV prevention and ensure that 95% of people at risk of HIV infection have access to and use appropriate, prioritized, person-centred and effective combination prevention options by 2025.
3.      Close gaps in HIV testing, treatment and viral suppression that are limiting the impact of HIV responses and achieve by 2025 the 95–95–95 testing and treatment targets within all subpopulations, age groups and geographic settings, including children living with HIV.
4.      Eliminate vertical HIV transmission and end paediatric AIDS.
5.      Put gender equality and the human rights of women and girls in all their diversity at the forefront of efforts to mitigate the risk and impact of HIV.
6.      Implement the GIPA (Greater Involvement of People Living with HIV/AIDS) principle and empower communities of people living with HIV, women, adolescents and young people and key populations to play their critical HIV response roles.
7.      Respect, protect and fulfil the human rights of people living with, at risk of and affected by HIV and ensure by 2025 that less than 10% of people living with HIV and key populations experience stigma and discrimination.
8.      Enhance global solidarity to close the HIV response resource gap and increase annual HIV investments in low- and middle-income countries to US$29 billion by 2025.
9.      Accelerate progress towards universal health coverage and strong primary health care systems, build forward better and fairer from COVID-19 and humanitarian crises, and strengthen global health security and future pandemic preparedness.
10.  Leverage the 25 years of experience, expertise and mandate of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in building multisectoral, multi-stakeholder and rights-based collaborative action to end AIDS and deliver health for all as global public good.

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.

Representatives of all stakeholders in the AIDS response came together virtually on 23 April for the interactive multistakeholder hearing ahead of June’s United Nations High-Level Meeting on AIDS.

Those taking part included people living with, at risk of and affected by HIV, representatives of Member States, parliamentarians, and representatives of local governments, civil society organizations, philanthropic foundations, academia, medical associations, the private sector, and broader communities. The objective of the meeting was to support Member States with the preparations for the high-level meeting through an interactive dialogue with communities, civil society and other key stakeholders.

In his opening remarks, the President of the General Assembly, Volkan Bozkir, applauded activists for their work in reducing the impact of the HIV epidemic.

“Your participation here today is not taken for granted. I understand that many of you began advocating and organizing after experiencing loss, suffering, discrimination, and marginalization. I commend you for sharing your lived experience in order to create a better world for all. Your resilience is unmatched.”

In her address to the meeting, the Executive Director of UNAIDS, Winnie Byanyima, said that it was the loud and persistent voice of people living with HIV and the communities most affected by the epidemic that had accelerated progress against the virus. Ms. Byanyima also underlined that the HIV response was closely linked to social justice issues.

“The struggle to end AIDS is inextricably linked with the struggle to end human rights violations, including discrimination and violence against women and girls and the marginalization and criminalization of people living with HIV and of key populations—sex workers, people who use drugs, gay, bisexual and other men who have sex with men, and transgender people.”

Faith Ebere Onuh is a young woman who was born with HIV and a member of the Association of Positive Youth Living with HIV and AIDS in Nigeria (APYIN). When she was 14 years old Ms Ebere Onuh started educating other young people living with HIV about the importance of adhering to their HIV medication. She has become a mentor and a voice for the voiceless, speaking up for young people in Nigeria.

“As a young person, I have learned in my time living with HIV and working with my community that to reach the target of ending AIDS by 2030, we must work together, as a global community. While as various individual member states we may be making progress, globally we are still off track, and some regions like mine, West and Central Africa, continue to lag behind.”

Neville Gertze, Permanent Representative of Namibia to the United Nations and co-facilitator for the preparations for the 2021 High-Level Meeting on AIDS, said lessons learned in responding to HIV and COVID-19 could be leveraged to improve health systems.

“By taking on board lessons learned through HIV, fighting COVID-19 can aid in reimagining systems of health to accelerate the health-related commitments of the 2030 Agenda for Sustainable Development. At the same time the HIV experience helps to inform COVID-19 responses, the unfolding response to the COVID-19 pandemic will undoubtedly yield lessons that can benefit both the HIV response as well as broader efforts to strengthen health systems.” 

There were four panels during the day to consider the following areas of the HIV response.

1. Equitable and equal access to HIV prevention, treatment and services.

2. Structural and social barriers to achieving HIV outcomes (zero new HIV infections, zero discrimination and zero AIDS-related deaths).

3. How to fully resource and sustain efficient HIV responses and integrate them into systems for health, development, social protection, humanitarian settings and pandemic responses.

4. Bringing it together: building synergies and addressing critical gaps.

A summary report of the interactive multistakeholder hearing will be available on the  President of the General Assembly website prior to the United Nations High-Level Meeting on AIDS, which takes place from 8 to 10 June 2021.

More than 150 civil society representatives from 17 countries in Asia and the Pacific joined the first virtual regional consultation on the upcoming United Nations High-Level Meeting on AIDS.

“Your views are important. We need them, and they really matter for the success of the political declaration,” said Mitch Fifield, Australia’s Ambassador and Permanent Representative to the United Nations and one of the two co-facilitators for the high-level meeting process, in his opening remarks. He also spoke about the valuable contributions of the participants to the high-level meeting and the critical role of communities in the HIV response.

The consultation was an opportunity for civil society organization leaders to take stock of the progress made and the challenges facing the HIV response in the region. It fostered cross-sharing of different expectations of the high-level meeting, allowing civil society organization representatives to share what they see as important for inclusion in the political declaration and to collect inputs to be shared with the multistakeholder task force in preparation for the multistakeholder hearing.

Asia and the Pacific has the second largest regional epidemic after Africa, with 300 000 new HIV infections in 2019. Key populations and their partners accounted for an estimated 98% of new HIV infections, and more than one quarter of new HIV infections were among young people (aged 15 to 24 years). At present, in Asia and the Pacific 160 000 people die from AIDS-related illnesses every year because they do not receive life-saving treatment in time, or the quality of care is insufficient. Nearly 2.3 million people living with HIV, or 40%, are not on treatment, signifying a need to increase treatment coverage.

The participants at the consultation stressed that the new political declaration should give prominence to the scale-up of HIV prevention and treatment efforts, including pre-exposure prophylaxis, self-testing, harm reduction services, same-day antiretroviral therapy, multimonth dispensing and comprehensive sexuality education. Strengthening health systems and the integration of HIV services with other health services, such as services for mental health, sexual and reproductive health, and tuberculosis, is seen as a priority for the next five years to ensure that no one is left behind. “To end AIDS, we must ensure universal, free and sustainable access to prevention and treatment services. The political declaration should be built on the last milestones, especially the Declaration on Universal Health Coverage,” said a civil society organization leader.

Community members recognized that policy and legal barriers, including the criminalization of sex work, consensual same-sex sexual relations and drug use, are deterring people living with HIV and key populations from accessing health services and undermining efforts to end AIDS. “Sex work and drug use are not crimes but a part of life for many. This should be strongly stated in the political declaration,” said one participant. Key population leaders made a strong statement about removing harmful laws, policies and practices towards key populations. They highlighted the need to strengthen the legal and policy environment to protect key populations and vulnerable groups from stigma, discrimination and violence. 

Current investments in the HIV response in the region reflect inadequate HIV financing, particularly for key population programming. Civil society organization leaders agreed that to ensure the sustainability of HIV programmes, increased political commitment for domestic funding and financing for communities and key populations programmes are critical. “Investments in HIV must be anchored on the principles of equity, social justice and accountability. These should include investments to support people-centred approaches to health service delivery where services are differentiated but integrated,” said another community representative.

The participants also considered the impact of the COVID-19 pandemic on communities in the region. The diversion of resources and health workers to respond to the more immediate COVID-19 pandemic presents a real risk, threatening the hard-fought-for gains of the HIV response. “We should ensure that the focus on HIV remains strong while dealing with COVID-19, and regular HIV services and uninterrupted supply of antiretroviral therapy should be guaranteed,” said a community leader. Communities also stressed the importance of a new political declaration that considers how COVID-19 has impacted community-led responses to HIV. “There should be financial commitments, a crisis fund or financial safety networks for key populations because they suffered immensely during the COVID-19 pandemic,” one participant said.

Throughout the consultation, the first and foremost demand has been for inclusiveness of key populations in decision-making. “If key populations and people living with HIV are not included in the highest level of decision-making, we will never end inequalities,” said another participant.  “Empowerment of communities is integral to strong and resilient health systems. It is important to enable the meaningful engagement of civil society organizations at all levels of programming, including policy development, service delivery, monitoring and evidence-generation,” said another participant.

The main points from the consultation will be synthesized into a regional civil society statement that captures the main priorities and demands of communities for the 2021 political declaration. Likewise, recently, UNAIDS Asia–Pacific launched a social media campaign to encourage key actors, governments, donors, stakeholders, civil society, academics and influencers to make their voices heard in the lead-up to the high-level meeting on the needs and priorities of the HIV response in Asia and the Pacific.

The UNAIDS Regional Support Team for Asia and the Pacific convened the consultation in collaboration with Sonal Mehta, the Regional Director of the International Planned Parenthood Federation South East Asia, and Jules Kim, of the UNAIDS Programme Coordinating Board nongovernmental organization delegation and Scarlet Alliance, representatives of the multistakeholder task force for the high-level meeting from Asia and the Pacific.

Following a public call for nominations, UNAIDS and the Programme Coordinating Board nongovernmental organization delegation has selected 16 representatives of civil society and the private sector from all regions to join the multistakeholder task force for the high-level meeting on HIV.

More than 560 nominations were received and the task force has been established with a broad and diverse expertise. There are at least two members per region. More than 50% of the members are women and 25% are under the age of 30 years. Six are openly living with HIV and all key populations are represented.

The United Nations General Assembly will hold its first high-level meeting on HIV since 2016 on 8–10 June 2021. In the run-up to the meeting, before the end of April 2021, an interactive multistakeholder hearing will be held with the participation of communities and other stakeholders, who will also participate in other activities before and during the high-level meeting itself. The task force will advise UNAIDS on the format, theme and programme of the multistakeholder hearing and will help to identify speakers for the hearing and high-level meeting plenary and panel discussions.

Multistakeholder task force members

Andrew Spieldenner, US PLHIV Caucus and MPact Global Action, United States of America

Souhaila Bensaid, MENA-ROSA, Tunisia 

Aaron Sunday, African Network of Adolescents and Young Persons Development and Association of Positive Youth Living with HIV in Nigeria, Nigeria 

Adilet Alimkulov, Kyrgyz Indigo, Kyrgyzstan

Jacqueline Rocha Cortes, MNCP National Movement of WLWA, Brazil

Phelister Abdalla, Key Affected Populations Health and Legal Rights Alliance, Kenya

Aleksey Lakhov, Humanitarian Action and Coalition Outreach, Russian Federation  

Judy Chang, International Network of People who Use Drugs, Italy

Sonal Mehta, International Planned Parenthood Federation, India

Yasmina Chan Lopez, Red Juvenil de AMUGEN, Guatemala

Alia Amimi, International Treatment Preparedness Coalition–MENA, Morocco 

Jacques Lloyd, Afrique Rehabilitation and Research Consultants NPC, South Africa 

Severin Sindizera, Indigenous Peoples Global Forum for Sustainable Development, Burundi

Angela Lee Loy, Aegis Business Solutions, Trinidad and Tobago

Jules Kim, Programme Coordinating Board nongovernmental organization delegation and Scarlet Alliance, Australia

Gideon B. Byamugisha, International Network of Religious Leaders Living with and/or Personally Affected by HIV, Uganda

Effective HIV responses require legal, policy and social environments that empower people living with HIV, those at higher risk of HIV infection and others affected by the epidemic to claim their rights and receive redress when those rights are violated.

Those who are responsible for enabling such legal, policy and social environments need to be properly trained. However, country reporting to UNAIDS in 2020 shows that training programmes on human rights and non-discrimination legal frameworks applicable to HIV are operating at scale at the national level for police and other law enforcement personnel in only 40 out 102 reporting countries, for members of the judiciary in 36 out of 100 reporting countries and for lawmakers and parliamentarians in 30 out of 97 reporting countries.

The United Nations General Assembly will hold its first high-level meeting on HIV since 2016 on 8–10 June 2021.  

In the run-up to the meeting, before the end of April 2021, an interactive multistakeholder hearing will be held with the participation of communities and other stakeholders, who will also participate in other activities before and during the high-level meeting itself.

To ensure the involvement of civil society and ensure an open, transparent and participatory process, UNAIDS is forming, by the end of March, a multistakeholder task force comprised of representatives of civil society and the private sector. The task force will advise UNAIDS on the format, theme and programme of the multistakeholder hearing and will help to identify speakers for the hearing and high-level meeting plenary and panel discussions.

Different constituency networks are asked to use their own networks and selection processes to nominate people to be considered for the task force. UNAIDS and the Programme Coordinating Board nongovernmental organization delegation will select individuals for each of the categories of members:

• One representative openly living with HIV of networks of people living with HIV.
• One representative openly living with HIV of networks of women living with HIV.
• One representative openly living with HIV of networks of young people.
• One representative of each of the key populations (people who use drugs, sex workers, transgender people, gay men and other men who have sex with men, people in prison settings).
• One member of the UNAIDS Programme Coordinating Board nongovernmental organization delegation.
• A representative of a women’s organization, particularly working on sexual and reproductive health and rights.
• A representative of a young’s people organization, particularly working on sexual and reproductive health and rights.
• A representative of the private sector.
• A representative of a faith-based organization.
• A representative of networks or organizations of indigenous people.
• A representative of networks or organizations of people with disabilities.
• A representative of an organization working with tuberculosis and HIV. 

“The engagement of people living with HIV, key populations and other priority communities is fundamental for the success of the high-level meeting. Communities have led the way in the HIV response since the beginning and know what is needed to make sure that all people everywhere have what they need to prevent new HIV infections and to ensure that people living with HIV can survive and thrive. The task force represents an important platform for participation in the preparatory phase for the meeting. As the task force is necessarily limited in size, we are particularly interested in nominations of people from networks, who are closely linked across their communities and across regions, to be able to bring a deep and broad perspective. Additional opportunities for people living with HIV, key populations and other affected groups to engage with be made available throughout the lead-up to the high-level meeting,” said Laurel Sprague, UNAIDS Chief/Special Advisor, Community Engagement.

Civil society networks and relevant stakeholders are asked to submit nominations here by 16 March 2021 at 18.00 CET. The call for nominations with detailed information can be accessed here.

GENEVA, 25 February 2021—UNAIDS welcomes the United Nations General Assembly decision for a high-level meeting on HIV and AIDS to take place from 8 to 10 June 2021. The high-level meeting will review the progress made in reducing the impact of HIV since the last United Nations General Assembly high-level meeting on HIV and AIDS in 2016 and the General Assembly expects to adopt a new political declaration to guide the future direction of the response. The high-level meeting will take place as the world marks 40 years since the first case of AIDS was reported and 25 years of UNAIDS.

“World leaders must seize the opportunity offered by this new United Nations General Assembly high-level meeting on HIV and AIDS to maintain their focus and commitment on ending AIDS as a public health threat as part of the 2030 Agenda for Sustainable Development,” said Winnie Byanyima, UNAIDS Executive Director. “The AIDS epidemic is unfinished business and must be ended for everyone everywhere, including for young women and adolescent girls and for other groups of people disproportionately affected by HIV. The right to health belongs to all of us.”

Progress towards ending the AIDS epidemic as a public health threat by 2030 as part of the Sustainable Development Goals has been highly uneven and the global goals for 2020 adopted in the 2016 United Nations Political Declaration on Ending AIDS were not met. Stigma and discrimination, the marginalization and criminalization of entire communities and a lack of access to health, education and other essential services continue to fuel the epidemic. Women and girls in sub-Saharan Africa and key populations (gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and people in prison) and their partners globally continue to be disproportionately affected by the HIV epidemic.

UNAIDS is currently developing a new global AIDS strategy for 2021–2026 through a process that is inclusive of all stakeholders in the AIDS response. The final draft strategy will be considered for adoption by the UNAIDS Programme Coordinating Board in March 2021. The new global AIDS strategy will include new targets to ensure that no one is left behind in ending AIDS, wherever they live and whoever they are. By achieving these targets, the number of people newly infected with HIV would fall to 370 000 by 2025, and the number of people dying from AIDS-related illnesses would be reduced to 250 000 in 2025.

Even the gains already made against HIV are threatened by the disruptions caused by the COVID-19 pandemic. The high-level meeting creates an opportunity to ensure that the world bolsters the resiliency of the HIV response to date, commits to rapid recovery post-COVID-19 and applies the lessons learned from the colliding epidemics of HIV and COVID-19 to create more resilient societies and health systems that are ready to meet future health challenges.

“The AIDS response has taught us that global solidarity is critical to making sustained progress against the impact of health threats like COVID-19,” said Ms Byanyima. “There must be concerted international efforts to reduce inequalities between countries and within them to strengthen the world’s capacity to absorb and defeat future global health challenges that put lives and livelihoods at risk everywhere.”

UNAIDS expresses its appreciation for the hard work of the high-level meeting co-facilitators, the permanent missions to the United Nations of Australia and Namibia, in the adoption of the resolution as well as to the President of the General Assembly for leading the process.

Given the constraints imposed by measures taken to contain the COVID-19 pandemic, it has not yet been decided if the high-level meeting will be in-person, virtual or a hybrid of the two. In line with the resolution, UNAIDS encourages the highest level of participation of United Nations Member States and the inclusion of civil society organizations and people living with or at risk of HIV in delegations to the high-level meeting. UNAIDS also looks forward to the multistakeholder hearing as a key opportunity to hear the voices of people living with, at risk of and affected by HIV, including key populations.

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.

Imagine using a health-care system that has no concept of you as a person, or of your unique needs. Nurses might not ask important questions. Doctors might overlook the solutions you really require. You might feel unwelcome.

That has always been the reality for transgender people in Jamaica. A new strategy seeks to change this.

With support from UNAIDS and the United Nations Population Fund (UNFPA), TransWave Jamaica has launched the Trans and Gender Non-Conforming National Health Strategy, the first of its kind in the English-speaking Caribbean. The five-year plan is a rights-based road map for how the health and well-being of transgender people can be advanced. It moves beyond recommendations for the health-care system to the structural and societal changes necessary to achieve equitable access to services and opportunities for the transgender community.

“Too many transgender people stay home and suffer or change who they are to access public health-care spaces,” explained TransWave Associate Director of Policy and Advocacy, Renae Green. “We need improvement to basic services, including psychosocial support. And we need transgender people to be able to access public health services as their authentic selves.”

Through the Unified Budget, Results and Accountability Framework Country Envelope for Jamaica, UNAIDS collaborated with UNFPA to support a robust year-long process of research, community engagement and strategy development, including a monitoring and evaluation framework. The strategy development process was informed by a multisectorial steering committee composed of civil society organizations, international cooperation partners and government authorities.

HIV is a major priority for the Jamaica transgender community. Around 50% of transgender women participants in two recent studies were living with HIV. But there are other pressing concerns. Two surveys found that around half of transgender respondents were unemployed. One third skip meals. One in ten sells sex to survive. Research conducted in 2020 by TransWave found that half of respondents had been physically assaulted in the past year, with 20% reporting sexual assault. More than 80% had been verbally abused.

“The needs go beyond HIV and health care. Other factors affect people’s ability to be safe, to be adherent or to remain HIV-negative. We should take into account the whole person, not just a part,” said Denise Chevannes-Vogel, HIV and AIDS Officer for the UNFPA Sub-Regional Office for the Caribbean.

“We value the fact that we were able to bring together the community to have a discussion about their needs beyond HIV,” said Ms Green.

The TransWave team led the community needs assessment. Some community requests, such as hormone replacement therapy or gender assignment surgery, are unique. But others are common to all people. They want access to health care and housing, education and employment. And they want to see themselves represented in the civil society spaces where many access care and support.

“We will not reach any AIDS-related targets if we do not prioritize transgender health as a whole. People are dying because of violence, living on the streets, lack of jobs and lack of opportunities. Even the HIV prevention knowledge that most people would acquire through formal education settings is not available to transgender people when they are bullied and forced to drop out. So this process was about reflecting on the impact indicators. What would it take for them to live longer, better lives?” said Ruben Pages, UNAIDS Jamaica’s Community Mobilization Adviser.

But what chance does this comprehensive and forward-thinking strategy have of succeeding in a country famed for its social conservatism? The partners are optimistic. On one hand, the approach calls for longer-term goals, including law reform around issues such as gender identity recognition and decriminalizing sex between same-sex partners. But the strategy is also a practical guide for transgender inclusion in systems and frameworks that are already in place. With targeted action there can be quick wins.

Manoela Manova, the UNAIDS Country Director for Jamaica, said the strategy will help the country accelerate progress to end AIDS.

“Going forward, there will be renewed focus on ensuring that excellent prevention, testing and treatment outcomes are achieved across all communities, especially key and vulnerable populations,” Ms Manova said. “This is an opportunity to make good on our commitment to leave no one behind.”

When Lineo Tsikoane gave birth to her daughter, she was inspired to intensify her advocacy for gender equality to give Nairasha a better life as a girl growing up in Lesotho.

“I think a big light went off in my head to say, “What if the world that I’m going to leave will not be as pure as I imagine?” I ask myself, “What kind of world do I want to leave my daughter in?”” she says.

As a result, Ms Tsikoane champions for women’s social, economic and legal empowerment at her firm, Nairasha Legal Support. It offers legal support for women in small and medium enterprises and women who are survivors of sexual and gender-based violence.

“Our main focus is gender-based violence, because this happens to be a country that has one of the highest incidences of rape and intimate partner crime in the world,” she says.

Even before the COVID-19 outbreak, violence against women and girls had reached epidemic proportions globally.

According to UN Women, 243 million women and girls worldwide were abused by an intimate partner in the past year. In Lesotho, it is one in three women and girls.

Less than 40% of women who experience violence report it or seek help.

As countries implemented lockdown measures to stop the spread of the coronavirus, violence against women, especially domestic violence, intensified—in some countries, calls to helplines increased fivefold.

In others, formal reports of domestic violence have decreased as survivors find it harder to seek help and access support through the regular channels. School closures and economic strains left women and girls poorer, out of school and out of jobs, and more vulnerable to exploitation, abuse, forced marriage and harassment.

The United Nations Population Fund (UNFPA) works together with UNAIDS, the United Nations Children’s Fund and the World Health Organization on 2gether4SRHR, a joint programme funded by the Swedish International Development Cooperation Agency, to address HIV and sexual and reproductive health in Lesotho.

During Lesotho’s lockdowns, UNFPA worked with Gender Links, the Lesotho Mobile Police Service and others to support efforts to prevent and respond to incidences of gender-based violence.

“We are ensuring that a helpline, where people experiencing gender-based violence can call, is in place and is working and we are also providing relevant information through various platforms for people to access all the information they need on gender-based violence,” says Manthabeleng Mabetha, the UNFPA Country Director for Lesotho.

Mantau Kolisang, a local policeman from Quthing, Lesotho’s southernmost district, characterized by rolling hills and vast landscapes, says one reason why gender-based violence is prevalent in Lesotho is because the law is not heeded in the rural areas.

“It’s difficult to implement the law since these are remote areas,” he says, adding that while he has made arrests, he has no transport to access far-flung areas in the small mountainous region. 

Lesotho’s law states that a girl can marry at the age of 16 years. However, Mr Kolisang says cultural practices, coupled with contraventions of the law, has made some men believe a 13-year-old girl “can be a wife”, exposing Basotho girls to violence.

“Men don’t regard it as a crime,” he says, adding that girls have been abducted from the mountains for forced marriages.

Between 2013 and 2019, 35% of adolescent girls and young women in sub-Saharan Africa were married before the age of 18 years. Girls married before 18 years of age are more likely to experience intimate partner violence than those married after the age of 18.

Because of poverty, gender inequality, harmful practices (such as child, early or forced marriage), poor infrastructure and gender-based violence, girls are denied access to education, one of the strongest predictors of good health and well-being in women and their children.

In Lesotho’s legal system, women are regarded as perpetual minors. This categorization infantilizes women, Ms Tsikoane says. A man who abuses a woman can often walk away unscathed from the justice system if he says the woman in question is his “wife”, she adds.

“This makes women vulnerable to commodification because a child can be passed around,” she says.

Ms Tsikoane says there is a direct link between the minority status of women and HIV infection in Lesotho. In 2019, there were 190 000 women 15 years and older living with HIV in Lesotho, compared to 130 000 men. 

Adolescent girls and young women between the ages of 15 and 24 years are particularly vulnerable. They accounted for a quarter of the 11 000 new HIV infections in Lesotho in 2019.

“My hypothesis is women cannot negotiate safe sex,” says Ms Tsikoane.

The dangerous reality that Basotho women live in worries Mr Kolisang. But due to a lack of institutional support and resources, he feels his actions have limited effect.

“I feel for these children. I feel for these women. I do feel for them. I can help, but the problem is how?” he laments.

Ms Tsikoane says she finds “trinkets of opportunities” for her and her colleagues to help their clients and navigate a legal system that is not favourable towards women.

“So, if you are not being well assisted at a police station, if you feel like someone is dragging your case and you are struggling to get an audience, we are there. We will support you and we will fight with you,” she says.