Since the beginning of the war in Ukraine, communities of people living with and affected by HIV have been at the forefront of ensuring the continuity of life-saving HIV services, both for those who remained in Ukraine and for those arriving in Germany as refugees.

At a special World AIDS Day event in Berlin co-hosted by UNAIDS and 100% Life Ukraine, community representatives and civil society activists thanked the German government and UNAIDS for their support and spoke about the continued challenges they face.

“Our journey exemplifies how the strength of perceived minorities and real community leadership can drive life-saving programmes and innovations that can impact the lives of millions of people,” said Valeriia Rachinska, Director of Human Rights, Gender and Communities at 100% LIFE Ukraine. “None of this would be possible without the support of international partners and donors. Global solidarity and support from our partners are the chance for a fair and thriving tomorrow for all, especially those living with HIV.”

100% LIFE is the largest patient-led organization in Ukraine which has as its mission to fight for life. The Network works with patients and for patients, including the representation of the interests of people living with HIV in 25 regions of Ukraine.

Since the beginning of the war in Ukraine, Germany has donated €1,050,000 in emergency funding to UNAIDS, empowering the provision of critical support to people living with and affected by HIV in Ukraine, Poland and Moldova. This includes providing temporary accommodation, humanitarian assistance, social protection, primary health care and testing for HIV, hepatitis C, STIs and tuberculosis. The emergency fund also covered the enrollment of people in HIV prevention and treatment programmes, offering comprehensive care and support.

Among the speakers at the World AIDS Day event was Silke Klumb, CEO of the German AIDS Federation, who underlined the importance of the partnership between government and civil society in ensuring continued access to HIV prevention, treatment and care services for people affected by the war in Ukraine.

"Community-led responses have been and continue to be critical in the HIV response, both in Germany and globally. Thanks to public funding Deutsche Aidshilfe has been able to engage in community-led prevention, counselling, testing, care, and support for 40 years now. Upon this foundation and through the broad network in Ukraine, Eastern Europe and Central Asia, Germany’s community-led organizations under the umbrella of Deutsche Aidshilfe were able to act immediately to Russia’s full-scale invasion of Ukraine,” said Ms Klumb. ”Over the last 18 months, we provided support, information, translations to people fleeing the war and linked them to care. Platforms such as self-help conferences and other meetings helped to strengthen the communities of people living with and affected by HIV. Deutsche Aidshilfe is committed to continue putting the communities at the centre of our work.” 

During the event, UNAIDS Deputy Executive Director of Policy, Advocacy and Knowledge, Christine Stegling, presented the new UNAIDS World AIDS Day report Let Communities Lead. The report shows how communities have been the driving force for progress in the global fight against HIV.  It shows that investing in community-led HIV programmes can have transformational benefits.

“Since the earliest days of the AIDS pandemic, community leadership has driven life-saving access to HIV treatment and prevention. Continued progress against HIV/AIDS in Ukraine - despite the war and its resulting refugee crisis - is the direct result of Ukrainian and German community leadership. A community-led response is well-positioned to maintain continuity of HIV prevention and treatment services, especially in times of crisis,” said Ms Stegling. “Continuity of HIV care is essential for achieving our ultimate goal of ending AIDS as a public health threat by 2030. UNAIDS thanks all community leaders who stepped up in these challenging times and we thank nations like Germany who understand the value of investing in a community-led response to HIV/AIDS - especially in times of war and other crises.”

The event was moderated by Peter Wiessner of Action against AIDS Germany.

HIV opt-out testing will consolidate the gains towards HIV epidemic control in the UK

LONDON/GENEVA, 29 November 2023—Ahead of World AIDS Day (1 December) UNAIDS welcomes a new research project to potentially expand ‘opt-out’ HIV testing programmes across England. According to NHS figures, a pilot ‘opt-out’ HIV testing scheme, pioneered by the Elton John Foundation in England has identified more than 3,500 cases of three bloodborne infections since April 2022—HIV, Hepatitis B and Hepatitis C—including identifying more than 580 HIV cases of HIV.

Under pilot scheme in England, anyone having a blood test in selected hospital accident and emergency units has also been offered a test for HIV, Hepatitis B and Hepatitis C, and has been given the option to opt out should they not wish to have the test. The trials have been taking place in 33 hospitals in London, Greater Manchester, Sussex and Blackpool.

"HIV opt-out testing will consolidate the gains towards HIV epidemic control in the UK," said Winnie Byanyima, Executive Director of UNAIDS. "Normalization of HIV testing will not only enable timely access to HIV treatment, allowing people with HIV to live healthy lives—it will also stop new HIV infections and reduce the stigma around getting an HIV test. It will save and change lives and help ensure that no one is left behind."

People living with HIV who are on effective HIV treatment cannot transmit the virus. In the UNAIDS Global AIDS Strategy, UNAIDS has set “95-95-95” targets. Aiming for 95% of people who are living with HIV to know their HIV status, 95% of people who know that they are living with HIV to be on lifesaving antiretroviral treatment, and 95% of people who are on treatment to be virally suppressed.

At least five countries, Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe have already achieved the “95-95-95” targets. A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65% of all people living with HIV, are also close to doing so.

On 28 November, UNAIDS released its World AIDS Day report in London, UK urging governments to Let Communities Lead across the world to in ending AIDS. The report shows that AIDS can be ended as a public health threat by 2030, but only if communities on the frontlines get the full support they need from governments and donors. The Elton John Foundation is one of the many organizations supporting community action.

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.

A new report by UNAIDS demonstrates the critical role communities play, and how underfunding and harmful barriers are holding back their lifesaving work and obstructing the end of AIDS.

LONDON/GENEVA, 28 November 2023—As World AIDS Day (1 December) approaches, UNAIDS is urging governments across the world to unleash the power of grassroots communities across the world to lead the fight to end AIDS. A new report launched today by UNAIDS, Let Communities Lead, shows that AIDS can be ended as a public health threat by 2030, but only if communities on the frontlines get the full support they need from governments and donors.

“Communities across the world have shown that they are ready, willing and able to lead the way. But they need the barriers obstructing their work to be pulled down, and they need to be properly resourced,” said Winnie Byanyima, Executive Director of UNAIDS. “Too often, communities are treated by decision-makers as problems to be managed, instead of being recognised and supported as leaders. Communities are not in the way, they light the way to the end of AIDS.”

The report, launched in London during a World AIDS Day event organized by the civil society organization STOPAIDS, shows how communities have been the driving force for progress.

Community advocacy from the streets to the courtrooms to parliaments has secured groundbreaking changes in policy. Communities’ campaigning helped open up access to generic HIV medicines, leading to sharp, sustained reductions in the cost of treatment from US$ 25 000 per person per year in 1995 to less than US$ 70 in many countries most affected by HIV today.

Let Communities Lead shows that investing in community-led HIV programmes delivers transformational benefits. It sets out how programmes delivered by community-based organizations in Nigeria were associated with a 64% increase in access to HIV treatment, a doubling of the likelihood of HIV prevention service utilization, and a four-fold increase in consistent condom use among people at risk of HIV. It also notes how, among sex workers reached by a package of peer-based services in the United Republic of Tanzania, the HIV incidence rate was reduced to below half (5% vs 10.4%).

“We are the vehicle for change that can end systematic injustices that continue to fuel HIV transmission. We have seen groundbreaking developments with U=U, improved access to medicines, and have made great strides in decriminalisation," said Robbie Lawlor, Co-Founder of Access to Medicines Ireland. “Yet, we are expected to move mountains without being financially supported. We are supposed to fight for a more equitable world and are tasked with dismantling stigma yet are side-lined in crucial discussions. We are at a tipping point. Communities can no longer be relegated to the periphery. The time for leadership is now.”

The report highlights how communities are at the forefront of innovation. In Windhoek, Namibia, a self-funded project by the youth Empowerment Group is using e-bikes to deliver HIV medicines, food and adherence support to young people who often cannot attend clinics due to their schooling hours. In China, community organizations developed smartphone apps that link people to self-testing which contributed to a more than four-fold increase in HIV tests across the country from 2009 to 2020.

The report reveals how communities are also holding service providers to account. In South Africa five community networks of people living with HIV inspected 400 sites across 29 districts and conducted more than 33 000 interviews with people living with HIV. In the Free State province, these findings led provincial health officials to implement new appointment protocols to reduce clinic wait times and three- and six-month dispensing of antiretroviral medicines.

“I am extremely concerned about the exclusion from health services of key populations like the LGBT+ community,” said Andrew Mitchell, Minister of State for Development and Africa. “The UK champions the rights of such communities, and we will continue to protect them, working closely with our partners in civil society. I thank UNAIDS for keeping us focused on the inequities driving the pandemic and I look forward to working with our partners to champion the voice of people living with HIV and end AIDS as a public health threat by 2030.”

Despite the clear evidence of community-led impact, community-led responses are unrecognized, under-resourced and in some places even under attack. Crackdowns on civil society and on the human rights of marginalized communities are obstructing communities from providing HIV prevention and treatment services. Underfunding of community-led initiatives is leaving them struggling to continue operating and holding them back from expansion. If these obstacles are removed, community-led organizations can add even greater impetus to end AIDS.

In the 2021 Political Declaration on ending AIDS, United Nations member states recognized the critical role communities play in HIV service delivery, particularly to people most at risk of HIV. However, whereas in 2012, when over 31% of HIV funding was channelled through civil society organizations, ten years later, in 2021, only 20% of funding for HIV was available—an unprecedented backsliding in commitments which has cost and is continuing to cost lives.

“At this time, community-led action is the most important countermeasure in the AIDS response,” said Solange Baptiste, Executive Director of the International Treatment Preparedness Coalition. “Yet, shockingly, it isn’t a cornerstone of global plans, agendas, strategies, or financing mechanisms for improving pandemic preparedness and health for all. It is time to change that.”

Every minute, a life is lost to AIDS. Every week, 4000 girls and young women become infected with HIV, and out of the 39 million people living with HIV, 9.2 million do not have access to lifesaving treatment. There is a Path that Ends AIDS and AIDS can be ended by 2030, but only if communities lead.

UNAIDS is calling for: Communities’ leadership roles to be made core in all HIV plans and programmes; Communities’ leadership roles to be fully and reliably funded; And for barriers to communities’ leadership roles to be removed.

The report features nine guest essays from community leaders, in which they share their experience on the achievements they have secured, the barriers they face, and what the world needs to end AIDS as a public health threat.

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.

Gathered in Amsterdam for the annual Fast-Track Cities conference between 25 ─ 27 September 2023, cities shared their various initiatives toward achieving key HIV targets.

In Nairobi, Kenya a situation analysis conducted at a granular level helped the county to better understand the gaps in the HIV response and to identify priority actions. The data showed that there was a lack of health service points, especially for key populations and young people living in informal settlements. In addition, stigma and discrimination also keeps people away. Zipporah Achieng, a young person living with HIV navigating the dusty streets of Kibera, one of several informal settlements, can attest to this. “Before, life was not easy, the healthcare workers were not well trained, and when they saw youth coming to the hospital, they would start judging them, discriminating them.”

The Nairobi City County, with the support of the USAID-funded joint UNAIDS-IAPAC Fast-Track Cities project, developed activities to create awareness, address vulnerabilities, and reduce discrimination with a focus on young people. Informal settlements house up to 60% of Nairobi’s population despite covering less than 10% of the city. Over a period of five years, community members worked hand in hand with healthcare providers in the establishment of 30 friendly health centres for young people and men who have sex with men and sex workers. As a result, stigma against people living with HIV has been reduced while the uptake of HIV and other health services increased significantly during this time.  

Ms Achieng is now a peer educator. She goes out in the community sharing her experience and getting people to come to the clinic. “Now I know what is right and what is wrong, I’m happy because life has changed, life is sweet, there is medicine, there is support, and I’m just happy,” said Ms Achieng.

Nairobi's commitment to fast-tracking HIV services for young people and key populations not only contributed to the city's own public health goals but also set an inspiring example for other urban centres in the country.

Discussions about sex and HIV in Indonesia remain taboo and information limited. As a result, HIV-related knowledge is low, especially among young people. In 2018, UNAIDS created an online chatbot named Tanya Marlo and integrated it in the popular messaging application LINE. “Before Marlo, finding reliable information about HIV and sexual health was really hard. It was difficult to get the right information”, says Arisdo Gonzalez, a user of the online application.

Support provided by the Fast-Track Cities project allowed this pilot to grow into a key tool to reach young people and increase HIV prevention and testing.

Last year alone, 200 000 engagements were recorded on social media and on average 100 users are directed to counselling every month. “Tanya Marlo has been an absolute hit among young people in Indonesia,” said Tina Boonto, UNAIDS Country Director in Indonesia. “Young people feel that they can chat with Marlo anytime, anywhere, and in secret, nobody has to know about it.” To ensure its sustainability and further development, a community group, YKS, has taken over the management of the application.

Kyiv joined the Fast-Track Cities initiative in 2016 and had made remarkable progress towards key HIV targets until Russia declared war in Ukraine. Many feared that treatment, HIV services and outreach would disintegrate.  Thanks to emergency funds and the support of the Fast-Track Cities project, a number of interventions were put in place to help those in need, in particular members of key and vulnerable populations like people who inject drugs and LGBTIQ+ members. “Since the invasion, we have managed to maintain our test numbers, didn’t lose a single patient, and ensured continued access to antiretroviral therapy” said Dr. Vitali Kazeka, Director of the Kyiv AIDS center.

One of Kyiv's notable achievements is the establishment of shelters designed to cater to the unique needs of key populations affected by HIV. These shelters provide a safe and supportive environment while also ensuring access to essential healthcare services, counseling, harm reduction programmes, and education about HIV prevention. “The Fast-Track Cities project makes people living with HIV, and those from key population groups, feel like equal citizens of the city… They see that there are special initiatives that care about them and their future,” said Nataliia Salabai, UNAIDS Fast-Track Cities focal person in Kyiv.

Launched in December 2014, the Fast-Track Cities partnership has grown to more than 500 cities and municipalities that have committed to accelerate their local HIV, tuberculosis (TB), and viral hepatitis responses to achieve Sustainable Development Goal (SDG) 3.3 by 2030.

More than half of the world’s population currently live in cities and cities account for a large and growing proportion of people living with HIV, tuberculosis (TB) and other diseases. The risk of contracting, and vulnerability to, HIV and TB infection is often higher in urban areas compared to rural areas, because of urban dynamics such as social networking, migration, unemployment and social and economic inequalities.

Thailand’s HIV response can provide important learning for other Southeast Asian countries, with the experience of having already reached 90-90-97 in the treatment cascade in 2022, on the way to the achieving the “triple 95s”. The country was first in the region to eliminate mother-to-child HIV transmission. AIDS-related deaths have declined by 65% since 2010. With support from Australia’s Department of Foreign Affairs and Trade (DFAT), UNAIDS helped organise for Thailand to share lessons it has learned in its HIV response with Indonesia through a south-to-south learning exchange mission of Indonesian delegates to Thailand.

On day one, the Indonesian Ministry of Health and Thai Ministry of Public Health delegates discussed the HIV epidemic, trends, and challenges in each country. They shared insights on HIV prevention, treatment and stigma reduction in the HIV response. The following day, the mission team visited community organisations— including the Service Worker in Group Foundation (SWING), a non-governmental organization working for sex worker rights, and the Rainbow Sky Association of Thailand (RSAT), an organization that offers sexual healthcare for men who have sex with men, migrants, people who use drugs, sex workers and transgender people.

Multidisciplinary care is provided in Thailand to people living with HIV and to key populations through community service providers, incorporating certified community counsellors, medical technicians and caseworkers at the community facilities, and through doctors, nurses, pharmacists and laboratory scientists through the telehealth system.

Indonesia’s delegates on the visit highlighted that they had found helpful areas to improve community engagement in their national HIV programme, with a focus on effectively addressing the barriers and limitations in the HIV response that are interlaced with stigma and discrimination across Indonesia.

“We learned how Thailand prioritised zero discrimination, one of which is developing an e-learning curriculum for healthcare workers to minimise stigma and discrimination in healthcare facilities,” said Dr Endang Lukitosari, who heads the National AIDS Programme of Indonesia’s Ministry of Health.

Thailand’s delegates shared experiences from their community complaint support and crisis response system. Health workers, communities and clients can use QR codes at various locations to report rights violations, promoting accountability and coordination between health facilities and community organisations.

The Ministry of Public Health of Thailand noted that community workers are actively involved in the HIV response throughout a robust system of accreditation for both individual community health workers and community organisations. There are health insurance options for all users, including three that can be accessed by migrants. These initiatives help create an enabling environment, led by the government, to connect communities with marginalised groups and tackle issues such as loss to follow-up.

Indonesia’s delegates noted the significance of community mobilisation in the HIV response and envisaged that by putting community in the centre they would reach the most marginalised and underserved groups across different islands and highlands in Indonesia.

“Thailand's comprehensive service delivery inspired me, especially through the Ministry of Public Health's accreditation and certification system for communities. This cooperative mechanism across the government and community stakeholders is the one we haven’t sufficiently addressed in Indonesia. Perhaps by applying this approach, we can minimise the gaps in the treatment cascade by ensuring we leave no one behind”, said Irfani from GWL-INA, Indonesia’s network of men who have sex with men and transgender people.

Over the five days, Indonesian delegates explored public HIV service centres and treatment facilities in Bangkok, Thailand and learned about how efforts of communities and government in HIV prevention and control could be streamlined and coordinated by enhancing the continuum of care and minimising loss to follow up. Notably, Thailand emphasised integrated, One-Stop, services as pivotal for a successful HIV response. Indonesia’s delegates sought a pathway for sustainability in the HIV programme through lessons from the continuity of HIV treatment services in Bangkok, which connects clients with community clinics and public health facilities through referral system and telehealth.

Delegates agreed that this learning mission highlighted key features in efforts to reduce stigma and discrimination, mobilise communities in HIV response, and improve access to quality healthcare by tackling barriers. In addition, the mission underscored efforts to support the delivery of client-centred services for key populations. The debriefing concluded with a commitment to continue the technical partnership on HIV between the two countries.

"I believe Indonesia can do it," said Krittayawan Boonto, UNAIDS Country Director of Indonesia. "Indonesia is in a similar situation to the one Thailand faced a few years ago. Thailand's strategies contributed to getting closer to their goals. I see potential in Indonesia to accelerate progress towards triple 95s. I hope these learnings from Thailand mission can advance the HIV response in Indonesia. UNAIDS Indonesia will keep supporting efforts to end AIDS by 2030."

Medical student Anaïs Maillat, 21, joined METIS (Movement of The Students Against Inequalities in Health Access) for a simple reason. The children’s beaming smiles drew her in.

As a member organization of the International Federation of Medical Students Association (IFMSA), the Swiss Medical Students Association (SWIMSA) Switzerland, launched the program CALWHA which works with children and adolescents living with HIV and AIDS in Tanzania.

Ms. Maillat focused on the Mwanza region where the rate of HIV infection is higher than the national average as its project coordinator.

“Our project is currently helping more than 400 children living with HIV and AIDS,” she said. “We organize activity days in hospitals where children and adolescents get check-ups, medicine, a meal, educational activities, and a safe space to play,” she added.

Activity days are held on three Saturdays of each month for children and adolescents aged 0 – 19 years old to improve clinic attendance and treatment adherence. “For many children, the hospital is far, so parents miss work, which has a cost,” Ms. Maillat explained. The project pays for people’s transportation to the hospital and that help allows many children to stay on treatment, according to CALWHA.

Like Ms. Maillat, medical students worldwide are taking an active role in the HIV response in their native countries.

Ana Laura Nascimento, a 21-year-old medical student and member of IFMSA Brazil, became an advocate for sexual and reproductive health rights through Pense Positivo, a project that organizes HIV awareness activities for houseless individuals and sex workers.  

During her school years, Ms. Nascimento said she realized there was a clear demand to educate her peers about sex due to sexually transmitted infection (STI) outbreaks. “We organized Testar é Saber (“testing is knowing”), a campaign to encourage students to get tested for HIV, syphilis, hepatitis B and C,” she said.

That led to information sessions at the university including doctors, public health professionals, and the municipality. As a result, the school now offers testing events twice a year.

Ms. Nascimento went on to lead and become a member of IFMSA Brazil’s National Officers for Sexual and Reproductive Health (NORA).

In Malaysia, another NORA leader, Joseph Hamzah Anwar, is a 25-year-old medical student and a member of Society of MMA Medical Students. He became an outreach worker for People Like Us Hang Out (PLUHO) - an LGBTQ organization based in Kuala Lumpur, Malaysia that focuses on mental health.

“I met doctors who are not sensitized to issues that HIV comes with and this discourages clients from seeking treatment,” he said. In his view, the younger generation of doctors need to be aware and knowledgeable, so people stay on HIV treatment and live their lives like any other person.

As members of IFMSA, these future doctors have been organizing activities with communities as part of the organization’s aim to strengthen its involvement in the HIV response.  They also seek to educate the public about HIV and AIDS and reduce stigma and discrimination in all healthcare facilities.

Representing more than a million medical students as their members, IFMSA also contributes to the Global Partnership to End All Forms of HIV-Related Stigma and Discrimination and holds a leadership role in The PACT, a global coalition of youth-led organizations advocating for sexual and reproductive health rights.  

On August 24, IFMSA, with the International Pharmaceutical Students’ Federation (IPSF) launched a Declaration of Commitment to HIV and AIDS. The Declaration will guide IFMSA and IPSF in their future efforts to contribute to the AIDS response.

All three future doctors hope that the declaration will encourage others to join the global youth movement to end AIDS. “With the activities outlined in the declaration, I believe we are on the right track to end AIDS by 2030,” Mr. Anwar said.

“I truly believe that young people have the potential to unite to end AIDS,” Ms. Maillat said. “We are the generation of unity. Let’s do this. You and me.”