“This isn’t your mother’s clinic!” said one amazed visitor.

From banners to brochures, all promotional materials are slick and cheerful. Smiling faces and toned torsos are everywhere. A purple colour scheme covers the whole building. Even files and staff face masks are colour coordinated. A pair of Facebook Live hosts have the good looks and energy of K-pop stars. And the organization’s slogan is decidedly upbeat: “where community fulfills your happiness”.

Over almost two decades, Thailand’s Mplus Foundation has refined a unique approach to providing comprehensive HV services to key population clients including men who have sex with men and transgender women.

Their method goes far beyond a cool brand identity. Mplus has leveraged domestic and international partnerships to create a key population-led health service with impressive results. They dispense more than half of the PrEP in Thailand’s Chiang Mai province.

This year they tested 95% of the almost 8000 people they reached with face-to-face services. Of those who tested positive, 91% were placed on treatment while the other 9% are in follow-up case management. And 100% of their clients who received viral load testing were found to be virally suppressed.   

“Community organizations can best reach key populations to receive services. We find that people who do not want to get tested at the hospital are comfortable with peers who they know understand their  life,” explained Pongpeera Patpeerapong, Director of the Mplus Foundation.   

Since its formation in 2003 Mplus has evolved to deliver a full range of services. They now have health centres in four provinces, while their mobile testing units serve clients in another five districts. They support a local hospital in each province, linking people to care and helping them with adherence. Mplus provides rapid testing, CD4 and viral load monitoring, and is also authorized to dispense medication. A small fleet of motorcycles even makes PrEP deliveries to clients in remote areas.

Both their online and offline engagements are anchored by a peer-led strategy. Their social media presence is commanding—everything from Twitter to Tik Tok. There are closed Facebook groups and special applications for clients to connect with community. Offline, they go beyond information booths to host parties and sport meet-ups. These aren’t just bonding exercises. Clients book appointments online and face-to-face interactions usually result in receiving an HIV test.

Mplus also provides technical assistance to other countries. It has supported an organization in Laos with online interventions and helped community groups in Cambodia develop campaigns to promote PrEP.

They played a key role in advocating nationally for the accreditation of community health workers. All Mplus staff are certified by the Department of Disease Control following a rigorous programme of study, evaluation and practice.

The programme continues to progress.  Mplus is strengthening their mental and emotional health support offering, and is working towards becoming certified to provide HIV and sexually transmitted infection (STI) treatment.

While in the past the programme was more heavily funded by the U.S. President's Emergency Plan for AIDS Relief through the United States Agency for International Development, today half of their investments come from branches of the National Health Security Office.

“Domestic funding is very important to develop our systems,” Mr. Patpeerapong said. “Community-based organizations have to be able to access domestic funding to cover more issues, including stigma and discrimination.”

Empowering key population-led health services has been crucial in improving Thailand’s HIV programme results. One of five people living with HIV in Thailand were identified and referred by a key population-led health service under the domestic health financing scheme. Four out of five people on PrEP in the country are served by community-led organizations. These services play a critical role in Thailand’s  strategy of Reach, Recruit, Test, Treat, Prevent, Retain.

“Thailand is well-positioned to be a leader in addressing the need for a sustainable community-led response as a critical part of the health infrastructure,” said UNAIDS Country Director for Thailand, Patchara Benjarattanaporn. “By creating an enabling system for health outreach we can address the challenge of late diagnosis and better reach key population communities with services.”

Thailand has integrated HIV services into its Universal Health Coverage scheme and increased investments in key population- and community-led health services. UNAIDS Programme Coordinating Board (PCB) members visited Mplus and other community-led health services ahead of the 51^st PCB meeting in Chiang Mai, Thailand.

CHIANG MAI, THAILAND, 15 December 2022—Community-led responses are a critical part of the AIDS pandemic response, and must be prioritised in resourcing. The approach, set out by governments, civil society organisations and United Nations agencies at an international meeting on AIDS in Chiang Mai, Thailand, will also be key for tackling other pandemics and for preparing for the pandemics to come, delegates said. The meeting saw the first international definition of a community-led response to a pandemic, published after a two-year consultative process that brought together 11 governments, representing each region of the world, and 11 civil society representatives. This UNAIDS multi-stakeholder task team on community-led responses was co-convened by the World Health Organization and United Nations Development Programme, and presented outcomes to the 51^st Programme Coordinating Board meeting of the UN Joint Programme on HIV and AIDS.

Using the new definitions and recommendations, German Federal Health Minister Prof. Karl Lauterbach and the UNAIDS Executive Director Winnie Byanyima published an article in The Lancet today calling for inclusion of comprehensive “community pandemic infrastructure” in pandemic prevention, preparedness and response in new planning, international agreements, and financing. In it, the leaders show that strong community infrastructure,  working synergistically with government, is a necessary but neglected element of effective pandemic prevention, preparedness, and response. Using evidence from AIDS, mpox, COVID-19, and Ebola, the authors describe how community-led organisations bring trust, communications channels, and reach to marginalised groups that complement government roles and improve equity.

The new international definitions and recommendations can help planners and funders for AIDS and other pandemics identify the elements of an effective community response. Community-led organizations, defined as "groups and networks, whether formally or informally organized ... for which the majority of governance, leadership, staff, spokespeople, membership and volunteers, reflect and represent the experiences, perspectives, and voices of their constituencies and who have transparent mechanisms of accountability to their constituencies,” form a backbone of that response. Crucially, it is noted that "not all community-based organizations are community-led.”

"While what is most often understood as infrastructure – like labs and hospitals – are important, also essential to effective pandemic response is the community infrastructure which includes people to do outreach, trusted voices who can speak to excluded communities, independent accountability mechanisms, and participation in decision-making,” explained Dr Matthew Kavanagh, UNAIDS Deputy Executive a.i for Policy, Advocacy and Knowledge. “This task team of governments, civil society, and international organizations has given important new tools to support the building and monitoring of community-led capacity. We will only be able to end AIDS and stop other pandemics by ensuring that this community infrastructure is intentionally enabled, strengthened, monitored, and resourced.”

The United Nations Joint Programme on HIV/ AIDS (UNAIDS) Board meeting in Chiang Mai included dialogue between member states and non-state participants on how to develop laws and policies to facilitate community-led response. The recommendations of the multistakeholder task team include developing better systems for financing community-led organisations, which often face legal, capacity, and eligibility barriers to national and international financing mechanisms; monitoring community-led capacity; and integrating data generated by community groups into response management. 

To end the AIDS pandemic, board members pointed out, community responses to HIV must be integrated into all levels of countries’ AIDS strategies including planning, budgeting, implementation, monitoring and evaluation.

The principles developed apply not only to AIDS. "Stopping COVID-19, mpox, and Ebola, and preparing for the next pandemic, all require that partnership of government and community together. The newly agreed framework for defining and measuring community-led responses make us better equipped to address the inequalities that are holding back progress in ending AIDS,” said Dr Kavanagh.

In Thailand, as delegates saw for themselves first hand, key-population-led health services have reached people at increased risk of HIV, achieving among the most equitable HIV responses in the region. In South Africa, community leaders with Ritshidze, which represents people living with HIV,  visit clinics and communities to assess COVID-19, HIV, and tuberculosis services and hold administrators accountable for addressing issues such as long waiting times or confidentiality gaps that keep some people away from health services. Amid war, Ukraine’s 100% Life, a network of people living with HIV, has used peer networks to communicate with displaced people, delivering medicines, food, and emergency assistance.

"International pandemic agreements and funding should include specific goals for community-led capacity," said Dr Kavanagh. "To be effective, pandemic responses need to move beyond one-way communications to bring communities into decision making at all levels. Community leadership is not mere nice-to-have. It is essential for ending pandemics."

The Lancet article marking the occasion by the German Health Minister and the UNAIDS Executive Director is here.

The report presented at the UNAIDS Programme Coordinating Board meeting is here.

Resources on Community Led Pandemic Response are here.

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.

The Sanpatong Hospital in North Thailand has reinvented and refined its HIV programme for more than three decades. It began attending to people living with HIV in 1989, and in 1996 started offering antiretroviral treatment.

“We have patients who have been with us for 30 years,” says Dr Tawit Kaewprasert, Deputy Director of Provincial Public Health Office and Director of Sanpatong Hospital.

In the last five years the hospital has not had a single case of mother-to-child HIV transmission. An impressive 96% of people on treatment who received viral load tests there this year were virally suppressed, with 98% of those patients being undetectable. Management speaks about the 92% retention rate for clients who were on treatment in 2022 in terms of how those results can be improved.

“We have not achieved that target just yet,” Dr Manusin Kongka says, referring to the proportion of people who stayed on antiretroviral therapy. “But we can reach the target and even achieve beyond 95%.”

The team even aims to achieve 100% viral suppression among people who have been on treatment for at least five years. The current 96% result isn’t considered to be good enough.

This ambitious goal-setting flows from the National HIV Policy and Thailand’s commitment to end AIDS by 2030 through a well-articulated strategy to reach, recruit, test, treat and retain people in care, while also working to prevent new infections.

 Of course the strategy relies heavily on Sanpatong and institutions like it. This 130-bed facility boasts a central lab that serves surrounding hospitals in Chiang Mai, Lamphun and Mae Hong Son with HIV diagnosis, CD4, viral load monitoring and some opportunistic infections testing.

Their approach includes the adoption of HIV response best practices including PrEP, index testing and same-day treatment initiation.

“Patients can start treatment before they even get their CD4 result,” Dr Kongka explained.

All staff have received anti-stigma training as well as orientation around the U=U, undetectable = untransmittable, initiative. The facility uses a differentiated approach for antiretroviral treatment delivery. Depending on their health status, some clients can collect multiple month dispensing at district health promoting hospitals while others can receive their medicine by mail.  

But a major key to Sanpatong’s success is the linkages it has made with groups of community-led organizations to drive case detection, linkage to care, psychosocial support and the monitoring of services. The Hospital works with Mplus, CAREMAT and FHI360 on prevention, testing and retention in care. Organizations of people living with HIV run support groups. The Community Led Monitoring team even helps primary care nurses to contact patients who have been lost to follow up and conduct home visits. The people living with HIV network collaborated with key community-based organizations in Chiang Mai to conduct community-led monitoring to improve the quality of HIV services at the Sanpatong hospital.

“Our collaboration with community organizations increases awareness about HIV, improves quality of care and access to care, decreases the waiting in community clinics and increases continuity of care for HIV patients,” said Ms Sineenuch Suwansre, HIV Coordinator.

This close collaboration with communities is enhanced by the Thailand Government’s move to integrate HIV services into the Universal Health Coverage scheme. Now certified organizations and lay HIV service providers can access domestic financial support within the national health infrastructure.

“Universal Health Coverage is a mechanism for the sustainable financing of HIV prevention as well as sustainable financial support to key population- and community-led health services. The Thai government’s move to fund Community-led Health Services as an element of the mainstream public health system is a win for people living with HIV, for HIV prevention and for sustainability,” said UNAIDS Thailand Country Director, Patchara Benjarattanaporn. 

DAR ES SALAAM / GENEVA, 29 November 2022—Analysis by the UN ahead of World AIDS Day reveals that inequalities are obstructing the end of AIDS. On current trends the world will not meet agreed global targets on AIDS. But the new UNAIDS report, Dangerous Inequalities, shows that urgent action to tackle inequalities can get the AIDS response on track.

UNAIDS set out earlier this year that the AIDS response is in danger—with rising new infections and continuing deaths in many parts of the world. Now, a new report from UNAIDS shows that inequalities are the underlying reason why. It shows how world leaders can tackle those inequalities, and calls on them to be courageous to follow what the evidence reveals.

Dangerous Inequalities unpacks the impact on the AIDS response of gender inequalities, of inequalities faced by key populations, and of inequalities between children and adults. It sets out how worsening financial constraints are making it more difficult to address those inequalities.

The report shows how gender inequalities and harmful gender norms are holding back the end of the AIDS pandemic.

“The world will not be able to defeat AIDS while reinforcing patriarchy,” said UNAIDS Executive Director Winnie Byanyima. “We need to address the intersecting inequalities women face. In areas of high HIV burden, women subjected to intimate partner violence face up to a 50% higher chance of acquiring HIV. Across 33 countries from 2015-2021 only 41% of married women aged 15-24 could make their own decisions on sexual health. The only effective route map to ending AIDS, achieving the sustainable development goals and ensuring health, rights and shared prosperity, is a feminist route map. Women’s rights organizations and movements are already on the frontlines doing this bold work. Leaders need to support them and learn from them.”

The effects of gender inequalities on women’s HIV risks are especially pronounced in sub- Saharan Africa, where women accounted for 63% of new HIV infections in 2021.

Adolescent girls and young women (aged 15 to 24 years) are three times more likely to acquire HIV than adolescent boys and young men of the same age group in sub-Saharan Africa. The driving factor is power. One study showed that enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%. When this is reinforced with a package of empowerment support, girls’ risks are reduced even further. Leaders need to ensure all girls are in school, are protected from violence which is often normalized including through underage marriages, and have economic pathways that guarantee them a hopeful future.

By interrupting the power dynamics, policies can reduce girls’ vulnerability to HIV.

Harmful masculinities are discouraging men from seeking care. While 80% of women living with HIV were accessing treatment in 2021, only 70% of men were on treatment. Increasing gender- transformative programming in many parts of the world is key to halting the pandemic. Advancing gender equality will benefit everyone.

The report shows that the AIDS response is being held back by inequalities in access to treatment between adults and children. While over three quarters of adults living with HIV are on antiretroviral therapy, just over half of children living with HIV are on the lifesaving medicine. This has had deadly consequences. In 2021, children accounted for only 4% of all people living with HIV but 15% of all AIDS-related deaths. Closing the treatment gap for children will save lives.

Discrimination against, stigmatization and criminalization of key populations are costing lives and preventing the world from achieving agreed AIDS targets.

New analysis shows no significant decline in new infections among gay men and other men who have sex with men in both the western and central Africa and eastern and southern Africa regions. Facing an infectious virus, failure to make progress on key populations undermines the entire AIDS response and helps explain slowing progress.

Around the world, over 68 countries still criminalize same sex sexual relations. Another analysis highlighted in the report found that gay men and other men who have sex with men who live in African countries with the most repressive laws are more than three times less likely to know their HIV status than their counterparts living in countries with the least repressive laws, where progress as far more rapid. Sex workers who live in countries where sex work is criminalized have a 7 times greater chance to be living with HIV than in countries where sex work is legal or partially legalized.

The report shows progress against inequalities is possible and highlights areas where the AIDS response has made remarkable progress. For example, while surveys among key populations often highlight lower service coverage among key populations, three counties in Kenya have achieved higher HIV treatment coverage among female sex workers than among the general population of women (aged 15-49 years). This has been helped by strong HIV programming over many years, including community-led services.

“We know what to do to end inequalities,” said Ms Byanyima. “Ensure that all of our girls are in school, safe and strong. Tackle gender based violence. Support women’s organisations. Promote healthy masculinities—to take the place of the harmful behaviours which exacerbate risks for everyone. Ensure services for children living with HIV reach them and meet their needs, closing the treatment gap so that we end AIDS in children for good. Decriminalize people in same-sex relationships, sex workers, and people who use drugs, and invest in community-led services that enable their inclusion — this will help break down barriers to services and care for millions of people.”

The new report shows donor funding is helping catalyse increased domestic funding: increases in external HIV funding for countries from PEPFAR and the Global Fund during 2018-2021 were correlated with increases in domestic funding from a majority of national governments. New investments to address HIV-related inequalities are urgently needed. At a moment when international solidarity and a surge of funding is most needed, too many high-income countries are cutting back aid for global health. In 2021, funding available for HIV programmes in low- and middle-income countries was US$ 8 billion short. Increasing donor support is vital to getting the AIDS response back on track.

Budgets need to prioritize the health and well-being of all people, especially vulnerable populations that are most affected by HIV-related inequalities. Fiscal space for health investments in low- and middle-income countries needs to be expanded, including through substantial debt cancellation and through progressive taxation. Ending AIDS is far less expensive than not ending AIDS.

In 2021, 650 000 people were lost to AIDS and 1.5 million people newly acquired HIV.

“What world leaders need to do is crystal clear,” said Ms Byanyima. “In one word: Equalize. Equalize access to rights, equalize access to services, equalize access to the best science and medicine. Equalizing will not only help the marginalised. It will help everyone.”

WATCH REPORT LAUNCH

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.

Grace Amodu was 7 years old when she found out she was living with HIV. Until then she had been told to take pills daily for malaria or for headaches but she grew tired of it. Screaming and kicking she told her brother that she was going to stop taking her medicine and that she wanted answers. Her mother took her aside and explained that she was born with HIV and that the treatment would keep her healthy like other kids.

She remembers crying a lot and refusing to leave the house.

To keep her from spiraling out of control her mom encouraged her to join a support group, which she says turned her life around.

As she proudly says she has two children who are both free of HIV. Taking her medication at the same time every day throughout her pregnancy and afterwards meant she was not going to transmit HIV to her babies. "When you take medicine it suppresses the virus and even though I feared my children may have HIV they both tested negative.”

She credits International Community of Women Living with HIV (ICW) Nigeria chapter for giving her hope and confidence.

“ICW was like a backbone, they were there for me like the colleagues, everyone around was standing for me, even the boss, Assumpta Reginald, was like a mother figure to me,” Ms Amodu said. “She held me by the hand telling me that, ‘You can do this and you can become a better person.’

As a result, Ms Amodu has become an HIV advocate and a community pharmacist.

"We go to the hospital and get medicine for people and give them to patients who are maybe not able to access their drugs because they have no transport fare or they are far away or due to the stigma in the hospital they don’t want to come to have nurses and doctors shout at them so we take these drugs down to their doorstep and give it to them,” she explained.

More than 90% of people living with HIV in Nigeria are on antiretroviral medicine but stigma and discrimination are still rampant.

For Ms Amodu the solution is simple. Give people the right information about HIV to break the cycle.

“We need to make people understand that you being HIV positive is not making you less of a human, you are also a human being and you deserve equal rights,” the 28-year-old said.

Stella Ebeh knows all about stigma. She started volunteering in 2004 helping people living with HIV like herself. Then she started working in a health center and became a public health officer. Over the years Ms Ebeh said she has cared for more than 7000 patients and also became a mentor-mother (giving HIV advice to pregnant women and counselling), and an anti-stigma ambassador.

She is very proud of overcoming stigma and as she called it, “walking on it,” but despairs that she is still not a full-time staff member. People living with HIV are very capable and yet we are often overlooked she said, adding, “I work like an elephant but eat like a rat.”

Patients pour in and out of the Marabara health centre on the outskirts of Abuja all day. Ms Ebeh goes from one person to another. She lingers a while with a pregnant woman who also prepares lunch on the premises, Ngozi Blessing.

Ms Ebeh insists on pregnant women taking all the precautions they can to give birth to healthy babies. Her husband and their five children are all HIV negative. Sadly, in Nigeria this is an exception.

Vertical transmission is 25% in the country - that is when a mother passes on the virus to her child during pregnancy or breastfeeding- a record high in the region.

UNAIDS Country Director Leopold Zekeng says this is unacceptable. For him it is a demonstration of the inequalities in terms of access to services.

“Two thirds of the 8 million women who get pregnant every year in Nigeria do not have access to PMTCT (prevention between mother to child transmission of HIV) services during ante-natal care,” he said.  

This is why Nigeria and UN organizations along with other partners are spearheading an effort to end AIDS in children.

Dr Akudo Ikpeazu, Director and National Coordinator, National AIDS and STDs Control Programme (NASCP) said that in the last 2 years they have done an enormous amount of work first trying to get a mapping to understand where all the women are having babies and where they receive ante-natal care if at all.

“A lot of them are in birth homes, they go to traditional birth attendants and many deliver at home and receive services at home and so we have a got new strategy which aims to find them where they are, ensure that they are treated, ensure that we can find them first, ensure that we can  test them, link them into treatment and count every single one that has gained access to care,” she said.

In other words, find all, test all, treat all and report all which happens to be Nigeria’s slogan encapsulating their strategy.

Once that vertical transmission tap, as she called it, is closed, then there will be a smaller pool of children to look after regarding treatment. Dr Ikpeazu said Nigeria intends to put in place an acceleration plan to have more children and adolescents on treatment and push for them to stay on treatment.

For Toyin Chukwuduzie, Director of Education as a Vaccine (EVA), HIV is one part of a larger equation.

“We see the number of unintended pregnancies, we see the burden of HIV especially among  adolescent girls, we also see the sexual and gender based violence happening in our society so these things are in existence, these things are happening, yet adolescents and young people don’t have the information they need to make decisions whether we are talking about schools, whether we are talking about health facilities or even in the homes where there are other adults so there are huge gaps,” she said.

The 35-year-old works with young people to fill those education gaps and build support. She is convinced that a main driver of these gaping holes are inequalities, one in particular.  

"I believe gender inequality is the root cause of many other inequalities so if had a magic wand gender inequality would be the one I would address the first because it’s key,” she said. “Addressing gender inequality is key to unlocking potential, potential of women and girls everywhere in this country.”

Hammering in her point, she added that despite everyone stressing the fact that young people are the force of the future Ms Chukwudize said, "If you are not providing that safe environment, if they are not healthy, if their dreams and aspirations are thrown off the path, how do they become the future that we want to see.”

GENEVA – Reflecting on 100 days since the 24th International AIDS Conference in Montreal, at which the World Health Organisation issued landmark guidance on how long-acting injectable anti-retroviral medicines can help prevent new HIV infections, and ViiV Healthcare committed to enabling access, AIDS campaigners are urging ViiV Healthcare to take vital next steps to enable timely rollout of game-changing,  life-saving, long-acting injectable HIV medicine to millions of people. 

At AIDS2022, the International AIDS Conference in Montreal, 29th July - 2nd August, ViiV Healthcare the manufacturer of cabotegravir (CAB-LA) committed to share technology, and ensure an affordable price, for the long-acting, injectable HIV medicine. The announcement generated international excitement as CAB-LA has been shown to be a safe and effective prevention tool. Reflecting on 100 days since then, global health leaders say there is an urgent need to for ViiV to take crucial next steps. 

ViiV committed at the Conference in Montreal to lower the price for CAB-LA in a subset of low- and middle-income countries. But ViiV has not yet published this price. Advocates say the annual per person price needs to be equivalent to the price of oral PrEP,  tens of dollars not hundreds of dollars. Multiple governments and financing agencies have indicated their interest in purchasing CAB-LA for PrEP if the medicine is offered at an affordable price point. Advocates are calling on ViiV to transparently and rapidly share details of their planned pricing strategy. 

“ViiV Healthcare needs to publicly announce an interim pricing strategy, which prioritises affordability so countries and procurement bodies can plan and purchase at scale,” said Dr Yogan Pillay, South Africa country director at The Clinton Health Access Initiative. “Governments and other procurers will only purchase long-acting injectable HIV medicines at scale if the drugs are affordable and if there’s a clear timeline as to when the drugs will be available.” 

While ViiV’s commitment to facilitate the generic production of CAB-LA via an agreement with the Medicines Patent Pool for use in 90 countries is helpful, HIV experts are calling on ViiV to allow an expansion of the number of countries eligible in order to accelerate progress in supplying the product to those in need. Although the current set of 90 countries includes both low- and middle-income countries, it excludes dozens of other middle-income countries, amongst which are countries with high rates of HIV infection. Expanding the list of countries would help incentivise generic production by expanding the potential market size. 

“ViiV Healthcare should allow generic production and supply in all low- and middle-income countries,” said Lilian Mworeko, Executive Director, International Community of Women Living with HIV East Africa. “Anything short of this would mean that millions of people who need these products would not be able to access them for years to come. Every day of delay would represent failure to prevent the spread of HIV and takes us further away from ending AIDS by 2030.” 

“At the AIDS Conference in Montreal, ViiV took important first steps to enable this powerful new prevention tool to reach many in need.  It is now time for ViiV to take additional courageous steps. These include ensuring registration with medicines agencies in all the countries with the highest rates of HIV, announcing the low price and expanding the set of countries allowed in the generic market. Bold actions by ViiV in this moment could help save millions of lives,” said Matthew Kavanagh, Deputy Executive Director, a.i. at UNAIDS. 

Global shocks, including the COVID-19 pandemic and the war in Ukraine, have further exacerbated risks for the HIV response in Eastern Europe and Central Asia. The growing HIV epidemic and several waves of migration and refugee crises in the region require urgent and considerable efforts to ensure access to essential HIV services for all people in need. Officials and community representatives from several countries of the region have discussed how to address those challenges using the recommendations of the new Global AIDS Report “In Danger’ during the launch of the Report in Almaty, Kazakhstan.

When the Republic of Moldova faced the first wave of refugees from the war in Ukraine, with 500 000 people passing through within the first few months, there was not much time to prepare.

Svetlana Popovichi, National Treatment Coordinator in the Republic of Moldova, explained: “The Government prepared a legislative framework so that all people, regardless of their residence and available documents, have access to necessary HIV services. Civil society and community organizations worked day and night to connect us to people in need. Together with partners, despite the huge flow, we provided all the necessary services, including PrEP and treatment for pregnant women. We were able to quickly redesign our treatment plans so that everyone—our people and refugees—living with HIV had equal access to treatment and services.”

“This is our universal recommendation for countries in crisis,” said Gabriel Ionascu, UNAIDS Country Director in Kazakhstan. “All people, including foreigners, have to have access to HIV services, otherwise the infection will spread further.”

According to Azamat Dysenov, Director of the Treatment Department in the Ministry of Health of Kazakhstan, the availability of antiretroviral medicines for Kazakhstan citizens living with HIV in the country is 100%. Treatment and prevention programmes are funded from the state budget and available for all Kazakh people free of charge. He said: “Today we are facing new challenges, including active migration movements. We are ready to strengthen cooperation with neighbouring countries, maximize the potential of civil society, and work together to remove barriers to access to HIV services for all who need them.”

“Stigma and discrimination towards people living with HIV and other vulnerable groups, which are worsening during the humanitarian crisis, continue to be the major block to an effective response to the HIV epidemic in this region,” said Eamonn Murphy, UNAIDS Deputy Executive Director and Regional Director for Eastern Europe and Central Asia. “HIV transmission, exposure and nondisclosure are criminalized in all countries. While the majority of countries have decriminalized same-sex sexual relations, stigma against gay men and other men who have sex with men remains common.”

According to the UNAIDS Global AIDS Update: In Danger, in 2021, 160 000 [130 000–180 000] people were newly infected with HIV in Eastern Europe and Central Asia, a 48% increase since 2010. The number of AIDS-related deaths in the region in 2021, at 44 000 [36 000–53 000], is 32% higher than in 2010, despite expanding HIV treatment coverage and availability of new prevention methods and measures to control opportunistic infections. According to UNAIDS, in 2020, 54% of new HIV diagnoses in the region were detected at the late stage (CD4+ <350 cells), which is 10% more than in 2018.

Amir Shaikezhanov, an activist and AmanBol Project Director in Kazakhstan, said it is important to remember “there are people behind these facts and figures. Stigma is difficult to measure, but it hugely impacts access to HIV services for different groups. My friend just recently died from AIDS because he was not ready to disclose his gay status and HIV-positive status, even to doctors.”

The “transgender community has been excluded and not visible for a long time. It is great that the report pays attention to this group, including to a high level of stigma towards transgender people,” said Victoria Primak, a transgender activist in Kazakhstan.

According to the UNAIDS report, COVID-19 exposed an epidemic of violence against women across the region. Baktygul Ismailova, Director of the Network of Women Living with HIV in Kyrgyzstan, emphasized that women living with HIV need protection from violence at all levels.

The report’s recommendations for the region include maximizing the availability of community-led, people-centred services; removing punitive and discriminatory laws, especially those criminalizing HIV and people from key populations; national action; and international solidarity in providing sustainable financing.

“Over the past two years, community organizations have proven their ability to adapt quickly to new challenges, address problems quickly in crisis situations, and provide people with the necessary HIV services. We are ready to take on all the work of providing services to key groups. We have people, experience, knowledge and understanding of what exactly and how exactly needs to be done. Give us this opportunity!” urged Nurali Amanzholov, Leader of the Central Asian Association of People Living with HIV.

Recent developments in the region, including the war in Ukraine, massive waves of refugees and migration, humanitarian challenges and economic slowdown, bring additional challenges in providing HIV and other health-care services to all people in need and ensure sustainable financing. Domestic funding for the HIV response in the region may slow down, and countries that still depend on international resources will not be able to ensure the sustainability of AIDS programmes.

“Consolidated efforts of countries and increased support from the international community are urgently needed,” said Eamonn Murphy.

HIV experts and implementers from around the world join UNAIDS in South Africa to set targets and put precision prevention programming into practice

JOHANNESBURG/GENEVA, 10 October 2022—New HIV infections are rising in an alarming number of countries, regions and cities around the world. There were 1.5 million new HIV infections in 2021—1 million higher than the 2020 target of 500 000. To support countries in driving down new infections UNAIDS and partners have brought together HIV prevention experts and implementers from the 28 countries with the highest rates of new infections to establish why they are failing to decline at scale, to discuss solutions and to help countries set ambitious prevention targets.

The 28 countries which account for three quarters all new HIV infections around the world are part of the Global HIV Prevention Coalition. The coalition was established in 2017 to build commitment, momentum, investment and accountability across governments, civil society, donors and the private sector to implement large-scale, high-coverage, equitable and high-quality prevention programmes.

During the three-day meeting participants will define country needs relative to implementing the 2025 Prevention Roadmap, develop critical steps required to implement the Road Map, including country-specific milestones, and identify strategic shifts required to work as a coalition and strengthen cross-country collaboration.

The meeting comes at a critical time. UNAIDS recent report In Danger showed that new HIV infections dropped by only 3.6% between 2020 and 2021, the smallest annual decline since 2016. It showed that in 2021, an adolescent girl or young woman (between 15—24 years old) became infected with HIV every two minutes and that 250 000 adolescent girls and young women were newly infected with HIV—more than 80% of whom were in sub-Saharan Africa. In this region adolescent girls and young women are three times more likely to acquire HIV than their male counterparts. Multiple vulnerabilities—including harmful social norms and practices, and social, economic and gender inequalities—are blocking progress for adolescent girls and young women.

“The urgency of making prevention work cannot be overemphasized,” said Anne Githuku-Shongwe, UNAIDS Regional Director for East and Southern Africa. “The opportunity we have now is to scale up what works while investing our attention on the stubborn social and structural barriers that keep girls and key populations vulnerable to new HIV infections.”

In 2021, UNAIDS estimated that key populations including gay men and other men who have sex with men, people who inject drugs, sex workers, transgender people, and people in prisons and other closed settings and their sexual partners accounted for 70% of new HIV infections worldwide showing that HIV prevention efforts must be concentrated among the marginalized and most vulnerable.

“Implementing this road map cannot be business as usual,” said Eamonn Murphy, UNAIDS Deputy Executive Director a.i. Programme. “We need to be honest—we need more political leadership, more investment and a greater commitment to reach key populations to drive down new HIV infections.”

When countries scale up combination HIV prevention programmes striking successes can be achieved. For example, Côte d’Ivoire’s early expansion of key population programmes and an increase in treatment coverage contributed to a 72% decline in new HIV infections between 2010–2020. In South Africa, new HIV infections decreased by 45% in that same period as the country expanded HIV treatment and voluntary medical male circumcision, while Kenya used the same approach to reduce HIV incidence by 44%.

In other regions, several countries have achieved steep reductions in new HIV infections by focusing their combination prevention programmes on the needs of key populations. In Cambodia, Thailand and Viet Nam, new HIV infections declined by more than 60% between 2010–2020. They also fell by around half in El Salvador, Republic of Moldova and Sri Lanka showing that progress is possible.

Dr Thembisile Xulu, National AIDS Commission Director for South Africa said, “This is a great opportunity for us to strategize and strengthen our relationships among countries, share experiences and rely on each other’s strengths to reduce the rate of new infections—the hard work starts now.”

Countries have committed to a new target of reducing new HIV infections to 370 000 by 2025, a target which is achievable, but only if efforts are stepped up to reach people being left behind. The HIV Prevention Roadmap has been designed to help countries reach their targets. It includes a 10-point plan and country specific milestones to get countries on track. The new HIV prevention targets include prioritized comprehensive packages of HIV prevention services and ensuring they are available and used by 95% of people at risk of HIV infection.

The meeting in South Africa was convened by the Global Prevention Coalition in collaboration with UNAIDS, UNFPA, the National AIDS Commission Forum and the Bill and Melinda Gates Foundation. 

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.