This story, by Duniya Aslam Khan in Imvepi refugee settlement, Uganda, is reproduced from UNHCR, a UNAIDS Cosponsor 

On a bright sunny day in northern Uganda’s Imvepi refugee settlement, Inga Viola and Rufas Taban sit comfortably under the shade of a jacaranda tree, leafing through an old register.

The pair are unrelated but share a unique bond – they were both diagnosed with HIV back in South Sudan, before civil war forced them to flee to Uganda in 2017.

“I was devastated when I found out,” says Inga, 32, who was diagnosed in 2014. “I felt like ending my life but I thought about my children and decided to live.”

Rufas, 49, nods solemnly, himself diagnosed in 2011.

Introduced to each other at Imvepi refugee settlement by their Ugandan nurse, Jedah Twebaze, they soon forged a friendship around their shared experiences – deep distress on finding out their status, leaving their homes behind and raising their families in exile.

They formed a support group, which they called the Friendship Serving Group, with Rufas, a former tax collector, as the secretary and Inga as the vice president. The group also doubles up as a savings cooperative and currently has 22 South Sudanese members, all HIV positive.

They contribute to the group’s kitty each month, sharing the accumulated savings at the end of the year. The group also helps spread HIV awareness in the community, while fighting the stigma associated with it.

“We use our meetings as an opportunity to talk about our wellbeing, check on members who are struggling with their status and provide counselling,” explains Inga.

She adds that they also educate each other on the importance of taking Antiretroviral therapy (ART) treatment – a life-saving course of medication that the conflict and the ensuing journey to safety disrupted, causing hers and Rufas’ health to deteriorate by the time they reached Uganda.

“I spent many days without taking medicine. Each new day without treatment meant getting closer to death,” she says.

Thanks to Uganda’s progressive refugee policy that has integrated refugees into the national HIV programme, refugees like Inga and Rufas are able to resume their treatment as soon as they arrive. They receive ART medication on a quarterly basis, free of charge.

The medications help suppress levels of HIV in the blood and slow damage resulting from the infection. It helps prevent progression from HIV to AIDS, thereby significantly extending life expectancy and reducing the risk of transmitting the virus to zero.

“I thought to be HIV positive meant dying soon but our kind nurse told us that with regular medication, we can live a very normal life,” says Inga, looking at nurse Jedah, who’s been nicknamed, ‘Dr. HIV’ by refugees for his advocacy and commitment to educate both refugees and Ugandans on HIV/AIDS.

Jedah works at UNHCR’s partner agency, Medical Teams International (MTI) and observes that the level of stigmatization among South Sudanese refugees has improved significantly.

“Educational sessions with the communities here have yielded positive results in fighting stigma,” he says.

According to UNAIDS statistics, by the end of 2018, an estimated 1.4 million Ugandans were living with HIV – 1.2 million were aware of their positive status and 72 per cent of them were on ART.  

Currently, over 17,000 refugees receive ART treatment across all the health facilities in Uganda’s refugee settlements where both refugees and nationals can access healthcare.

Earlier this year, Uganda launched a multi-year, Health Sector Integrated Refugee Response Plan, aimed at strengthening refugee healthcare through an integrated approach. Health services to refugees are currently aligned to the country’s national health policy and Health Sector Development Plan.

Such progressive policies and programmes that support both refugees and their host communities will be among the topics under discussion at the Global Refugee Forum, a high-level meeting 17-18 December in Geneva. States, the private sector and others are expected to announce high-impact contributions that will give refugees a chance to thrive alongside their hosts.

For Inga and Rufas, unrestricted access to treatment and a positive attitude towards HIV patients has not only made their life in the refugee settlement easier but it has also alleviated stigma.

“People here treat HIV patients just like anyone who has any other illness,” says Inga. 

Another key milestone is the decline in mother-to-child transmission rates. Eighty-nine per cent of pregnant women who visited health centres were tested for HIV to prevent transmission to the unborn child.

“It is through these interventions that Inga and Rufas’ children are all HIV negative,” explains nurse Jedah.

The strong advocacy role played by communities in fighting stigma and spreading awareness is recognized in the theme of this year's World AIDS Day on1 December,  which is ‘Communities make the difference.’

While Inga and Rufas do their part to make a difference, more needs to be done to ensure that the AIDS response at national and international level remains an essential one.

“Let us control HIV because no one should contract this disease,” Rufas says. “As we know, prevention is better than cure.”

On the eve of the United Nations Climate Action Summit, taking place in New York, United States of America, on 23 September, it is clear that climate change is now affecting every country on every continent. Often, the impact is greatest in regions already facing other challenges, with vulnerable groups of people, including people living with HIV, the most affected.

When Cyclone Idai made landfall near Beira, Mozambique, on 15 March 2019, heavy rain and strong winds caused flash flooding, hundreds of deaths and widespread damage to homes and infrastructure. By 19 March, it was estimated that 100 000 people were needing rescue. Communications in the city were down and all 17 of the city’s hospitals and health clinics suffered severe damage.

It would have been a devastating blow anywhere, but even more so in the province of Sofala, where around one in six of the adult population is living with HIV. When the floodwaters surged, many people simply saw their medication washed away.

Less than six weeks later, on 25 April, Cyclone Kenneth smashed into northern Mozambique. Overall, catastrophic flooding from the two storms affected around 2.2 million people in Malawi, Mozambique and Zimbabwe.

Warmer sea surface temperatures and rising sea levels are contributing to an increased intensity and destructive capacity of hurricanes and tropical cyclones such as Idai and Kenneth in many countries already inclined to extreme weather events.

When Hurricane Kenneth hit Zimbabwe, the acting UNAIDS Country Director, Mumtaz Mia, said that her priority was to make sure that people living with HIV, including pregnant women enrolled in prevention of mother-to-child transmission of HIV programmes, could access HIV treatment.    

“In Zimbabwe, where emergencies are not a new phenomenon, people living with HIV were left stranded when their medicine got washed away.”

After the cyclone hit, Ms Mia and her team met with representatives of the government, civil society, donors and other partners to discuss the response. They quickly ensured that the specific needs of people living with HIV were embedded in relief operations. This included coordination with partners, including UNAIDS Cosponsors, the Ministry of Health and Child Care and the National AIDS Council, to ensure the distribution of antiretroviral medicines and condoms, food packages for people living with HIV and safe deliveries for pregnant women. They also established assessments to address additional health and HIV needs related to the disaster.

In Malawi, Cyclone Idai affected almost 1 million people and forced more than 100 000 to flee their homes. Many people hit by the storm in Mozambique crossed the border to seek food and shelter.

For people living with HIV, concerns about their health and access to medication compounded an already difficult situation. For many, their first thought was how to save their medication.

“When the floods came, my house was destroyed. But I managed to reach for my plastic bag, where I keep my antiretroviral medicines, because they are one of my most precious possessions,” said Sophia Naphazi.

Elizabeth Kutendi said her medicines were safe only because she stores them in the roof of her home.

Both women found safety in Bangula, a settlement in the south of Malawi, which offered refuge to thousands of displaced people from surrounding villages. The settlement’s small clinic provided HIV counselling and testing, refills of HIV treatment and psychosocial support.

In other parts of Africa, a lack of rainfall is the main challenge for many people, causing severe drought and disrupting access to essential services, such as health care. Southern Africa has experienced only two favourable agricultural seasons since 2012. Angola, Botswana, Lesotho and Namibia have all declared drought disasters.

Competition for drought-depleted resources in the Horn of Africa has led to conflict, making it more difficult to reach groups of people in need of emergency assistance, including health care. Many have no choice but to flee to urban centres, placing increased pressure on service providers there. As conditions deteriorate, large-scale migration may result.

“Climate change is a threat to all of us,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “But vulnerable groups of people, including people living with and affected by HIV, are particularly exposed to the increased intensity of extreme weather events happening in areas of the world where coping mechanisms are already threadbare. Climate change must now be regarded as one of the most significant challenges to people’s health and well-being.”

When Cyclone Idai hit Mozambique and the eastern part of Zimbabwe in mid-March, it couldn’t have come at a worse time. A month earlier, Zimbabwe had issued an emergency appeal for some 5.3 million people affected by an ongoing economic crisis, and limited rainfall had ruined crops. The sudden pounding rain and wind threw everything into chaos. Three hundred people died, hundreds disappeared and 40 000 lost their homes. Food insecurity plus a lack of basic services, including health care, skyrocketed in the hardest hit province of Manicaland.

For Mumtaz Mia, the UNAIDS Acting Country Director in Zimbabwe at the time, the most pressing issue was to ensure that people living with HIV, including pregnant women enrolled in prevention of mother-to-child transmission of HIV programmes, could access HIV treatment.

“In Zimbabwe, where emergencies are not a new phenomenon, people living with HIV were left stranded when their medicine got washed away,” she said.

For her, preparedness is key. “For the AIDS response, we must anticipate any disruptions to services that emergencies bring.”

Born in Malawi, Ms Mia has dealt with droughts and floods throughout eastern and southern Africa. She also spent some time in Kenya dealing with post-election conflict and worked five years in South Sudan for UNAIDS before her stint in Zimbabwe.

She recounted that the UNAIDS country office met with the government, civil society, donors and other key stakeholders to discuss immediate action. Quickly, they made sure that HIV-specific needs were integrated in the emergency response. That meant coordinating, with UNAIDS Cosponsors, the Ministry of Health and Child Care and the National AIDS Council, to ensure the distribution of antiretroviral therapy and condoms, food support for people living with HIV and safe deliveries for pregnant women. They also set up assessments to address additional health and HIV needs following the disaster.

Almost 150 000 people living with HIV were in the cyclone-affected districts, and about 83% of them were accessing antiretroviral therapy. Most of them experienced a disruption of treatment during the crisis.

“Without a clear plan and instructions on action that needs to be taken in an emergency, precious days and weeks can be wasted trying to figure out what to do,” Ms Mia said.

She also believes that interagency contingency plans with specific tasks assigned to each agency to be taken in the event of an emergency would help action to be taken more quickly. “Using simple and clear guidance on the actions required by UNAIDS in emergency situations and the impact they can have on HIV are critical to guide country offices and managers,” she said, adding that “It’s important to earmark financial resources so that you can access and use the money right away.”

She practises yoga to help cope in times of stress and praises her supportive husband. “We try to have a semblance of a normal life at home during chaotic times,” she said, although she admits that often it is not easy. Throughout, she focuses on the people that needed her help. “I leave my door open, I listen to their stories and that gives me perspective to forge ahead.” That’s why she reiterated that in time of need, you cannot let people down. “Speed is of the essence.”

The UNAIDS Country Director for the Bolivarian Republic of Venezuela, Regina Lopez de Khalek, agrees. “In a humanitarian emergency, you have to act really quick in order to save lives, which means reinventing your everyday tasks to focus solely on the crisis,” she said.

In her case, she is dealing with the impact on people living or affected with HIV, of a political and economic crisis that affects more than 80% of the population. Inflation in the Bolivarian Republic of Venezuela has exploded, making basic food items beyond reach. Shortages have plagued the country, and medicine is no exception. Since May 2019, the country has recognized that there are some “humanitarian needs”, facilitating the delivery of medicine and rapid HIV and syphilis tests. With the help of international nongovernmental organizations, almost 60 tonnes of life-saving medicine have been delivered to the country. UNAIDS also worked for the country to receive emergency funds from partner organisations.

More recently, UNAIDS, the United Nations Population Fund and the Office of the United Nations High Commissioner for Refugees have jointly focused efforts to help people affected by stigma, discrimination and sexual violence. This included distributing post-exposure preventive kits, an emergency medical response for people exposed to HIV, to health services and introducing HIV tests to maternity units, as well as supporting civil society.

For Ms Lopez de Khalek, working jointly with other United Nations agencies and partners on the ground makes all the difference. “Not only does working hand in hand make sense, but it allows the AIDS response to stay relevant in a humanitarian situation,” she explained.

She recommends following the Inter-Agency Standing Committee HIV Task Force in Humanitarian Settings guidelines, but not to overlook the local and national context. “Know and understand the situation of the country you are in,” she said, “because although emergencies may seem equal, each crisis takes on the particularities of the country in which they occur.” And be proactive. “Act accordingly in advance, so that you are not just reacting,” she said. In her mind, it’s key to set up relationships, collaborate and engage with others and build a comprehensive response so that in the event of an emergency you and the people you are there to help are not left behind.

Simone Salem echoes that sentiment. “The key asset that helped me to respond to emergencies has always been the number of contacts I had across the countries as well as good relations with key people who were able to help,” the UNAIDS Community Mobilization Adviser in the Middle East and North Africa region said.

She added that when you start acting and giving concrete help, people will trust you and seek your support.

Ms Salem describes her work in Iraq, Libya and the Syrian Arab Republic as life-changing. “With each person I help, I realize the importance of my job and how crucial it is to always be alert to people’s needs,” the Egyptian said.

Recently, she helped people migrating or fleeing their homes to access HIV treatment and counselling. With the help of activists and regional networks, she supported the evacuation of lesbian, gay, bisexual and transgender (LGBT) people who had been targets of violence.

In times of crisis, she admires the solidarity that sprouts up at all levels. For example, Tunisians recently offered to give surplus HIV treatment to Libyans. The same occurred at the height of the Syrian conflict, with Lebanese people donating medicine.

Over time, she has become a much better decision-maker. Her secret? “Listen to what is said and also what is not being said, when analysing complex situations,” Ms Salem explained.

In her mind, it’s not a question of gender but of personality, although she said that women and vulnerable people she worked with came to her because they felt that she may be more supportive. The only regret she has is when she cannot help someone. “That’s very hard.”

Using her heart is how she explained she listened to people. When young LGBT people came to her saying that her comforting words had given them hope, she was touched.

“That was so precious to me and really keeps me going," Ms Salem said. “I push and push so that people are treated fairly and with compassion.”

In Africa alone, there are currently seven peacekeeping operations and a large number of other humanitarian operations. Across the continent, 600 million people live in countries affected by fragility, conflict and violence and seven out of 10 women in conflict settings and in refugee populations are exposed to sexual and gender-based violence. In certain contexts, women who have experienced violence are 50% more likely to be living with HIV.

Uniformed personnel working in peacekeeping operations are routinely exposed to a range of health risks during their work, owing to the type of work they do, the locations they are sent to and the conditions in which they often have to serve. The health and welfare of uniformed personnel is therefore a matter of concern. Of equal importance, however, is the well-being of the people among whom the uniformed personnel work.

In order to protect both deployed personnel and civilians, a new code of conduct on preventing and reporting sexual and gender-based violence, including among peacekeeping operations, was drawn up by the African Union in November 2018.

“We urgently need a more overarching, concerted and harmonized strategy to tackle the issues of sexual and gender-based violence and HIV during conflicts and in humanitarian settings,” said Bineta Diop, the African Union Special Envoy for Women, Peace and Security.

The new code of conduct, outlined in the African Union policy on the prevention of and response to sexual exploitation and abuse during peacekeeping operations, prioritizes the elimination of all forms of gender-based violence and puts peacekeeping operations at the forefront of ensuring justice and the protection of vulnerable populations. The challenge now is to implement the code of conduct.

“The African Union has zero tolerance for sexual and gender-based violence and calls for the immediate implementation of policies by member states that use a survivor-centred approach and offer the full range of support services,” said Admore Kambudzi, Director of the Peace and Security Department of the African Union Commission.

In June, the African Union Commission and the UNAIDS Liaison Office to the African Union, in collaboration with the United Nations Office to the African Union, convened the first of a series of meetings to formulate practical recommendations for a collective way forward in addressing sexual and gender-based violence and HIV in fragile settings.

The participants agreed that it is essential to develop a survivor-centred approach to conflict-related sexual violence based on developing the resilience of survivors and to provide mental health and psychosocial support. Including men and boys in ending sexual and gender-based violence will be key to success.

The participants also called for the health and well-being of the uniformed personnel of peacekeeping operations to be ensured, both before and during active service. A protocol on integrating HIV programmes in African Union peacekeeping operations will be finalized and a team of experts to map the current situation in crisis-affected countries, to identify gaps and areas of strength and to suggest a way forward to end sexual and gender-based violence and exposure to HIV will be assembled.

“I urge partners to take action to eradicate sexual and gender-based violence and HIV in fragile settings within the context of the African Union theme for 2019, the Year of Refugees, Returnees and Internally Displaced Persons,” said Clémence A. Habi Bare, the Director of the UNAIDS Liaison Office to the African Union.

Bangula settlement in Nsanje District, in the south of Malawi, is an arduous five kilometre walk from the border with Mozambique.

It is a walk that approximately 2 000 Mozambicans have made since they were displaced a month ago by the floods caused by Cyclone Idai. The settlement is also a temporary home to approximately 3 500 Malawians from surrounding villages who were also displaced.

Being predominately a small holder farming community, their homes, belongings and livelihoods were all washed away by the floods. They are now at Bangula, waiting for the earth to dry so they can go home and begin rebuilding their lives.

The emergency response to assist the 81 000 people in the district affected by the floods is being coordinated by the Government of Malawi, the United Nations, development partners and non-governmental organizations.

Upon arrival at the settlement, heads of households are provided with mats and blankets to sleep on and maize meal to cook.

Women and children are housed in 21 tents to the rear of the settlement, while others sleep under open industrial sheds, on concrete floors under tin rooves.

On a visit to the camp, Michel Sidibé, UNAIDS Executive Director, heard that while some amenities are being provided, there is not enough shelter for everyone and there is no lighting at night, which exacerbates vulnerabilities, especially of women and children.

It is well known that sexual and gender-based violence against women and children is heightened in emergency settings such as the one at Bangula. People also spoke of a lack of adequate nutrition, access to clean water and sanitation as well as their experiences of stigma and discrimination.

The small clinic at the settlement mostly focuses on primary health care and offers antenatal and postnatal services, HIV counselling and testing, refills of HIV treatment and psycho-social support.

While at the settlement Mr Sidibé spoke to a group of people living with HIV who had come to the settlement for shelter. They spoke of how, when the floods came, they tried to keep their HIV treatment safe from the water.

“When the floods came, my house was destroyed. But I managed to reach for my plastic bag where I keep my ARVs, because it is one of my most precious possessions,” said Sophia Naphazi, who resides in Jambo village in the district.

Elizabeth Kutenti, another women living with HIV, spoke of how her pills were safe because she keeps them in the roof. “They are my life,” she said.

The support people at the settlement need to return home is modest. “We need three things: a plastic sheet to cover what is left of our homes; maize seeds to plant and a hoe. Then we can go home,” said Miliam Moses.

“The level of resilience I have seen today is just amazing,” said Mr Sidibé. “The most important message I have heard today is one of hope.”

Mr Sidibé was accompanied by Atupele Austin Muluzi, Minister of Health and Population in Malawi. He thanked the UN agencies and the government departments supporting coordinating in the emergency response.

“We need continued support so that all the people in this settlement get the help they need so they can return home and live in dignity,” he said.

New initiative launched to engage the military and other uniformed personnel in HIV awareness, prevention and treatment and eliminate sexual and gender-based violence by defence and security forces

BANGUI/GENEVA, 9 October 2018—UNAIDS has signed a memorandum of understanding (MoU) with the Ministry of National Defence and Reconstruction of the Army, the Ministry of Health and Population and the National AIDS Committee of the Central African Republic. The aim of the MoU is to reduce new HIV infections within the military and other uniformed personnel, reduce sexual violence and abuse by security and defence forces and increase uptake of HIV treatment, care and support services.  

The MoU comes at a critical time. The Central African Republic has the second highest HIV prevalence in central Africa, estimated at 4% in 2017. However, among uniformed personnel, HIV prevalence is double, at an estimated 7.8%. Knowledge of HIV among uniformed personnel in the Central African Republic is particularly low and reports of sexual abuse and violence by military personnel are widespread.

"We have a responsibility to protect all our people from violence and HIV, especially women and girls, who are the most vulnerable. By focusing on uniformed personnel, we aim to transform the relationship between the new army and the population, as a key to reconstruction,” said Faustin-Archange Touadéra, President of the Central African Republic.

Under the MoU the parties involved will mobilize national partners to respond to HIV and gender-based violence within the defence and security forces, reduce HIV prevalence and incidence and improve relations between the defence and security forces and the general population through integrated activities around HIV prevention and gender-based violence.

“This protocol is a first,” said Michel Sidibé, Executive Director of UNAIDS. “It translates Security Council resolution 1983 into concrete actions. It places prevention at the centre of our efforts to end gender-based violence as a cause and consequence of HIV. This is essential and complementary to all efforts to strengthen accountability for sexual violence in the Central African Republic.”

Special emphasis will be given to training and awareness-raising for defence and security forces using methods proven to be effective in reducing gender-based violence and preventing HIV. These include improving mechanisms to report sexual violence, support for survivors and ensuring access to effective HIV prevention tools. Social and psychosocial support programmes will also be made available for members of the defence and security forces and their families.

The main beneficiaries of the programmes and activities will be the defence and security forces in the Central African Republic, which include the military, the police, the gendarmerie, customs officials, water and forestry officers and the municipal police. The implementation of the MoU will also benefit the wider population through planned integrated activities between the military and civilians and through the impact of HIV prevention, treatment and care programmes and efforts to eliminate sexual and gender-based violence and abuse.

UNAIDS will provide leadership and technical support to the initiative and will mobilize its partners and Cosponsors, particularly organizations working on gender and health issues, to support the implementation of the activities outlined in the MoU. UNAIDS will also ensure effective collaboration between all project partners, including ensuring the active participation of civil society. It will also play a critical role in advocating for resources and supporting the monitoring, evaluation and documentation of the initiative.

The United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic and the European Union Military Training Mission in the Central African Republic have committed to support the initiative.

The new commitments will play an important role in advancing the National Recovery and Peacebuilding Plan 2017–2021 in the Central African Republic and are part of ongoing efforts to implement United Nations Security Council resolution 1983, which underlines the importance of concerted efforts towards ending sexual and gender-based violence and responding to HIV in conflict and post-conflict settings.  
 

HIV data for the Central African Republic in 2017:

• 160 000 [130 000–190 000] people were living with HIV
• 53% of people living with HIV knew their HIV status
• 32% of people living with HIV were accessing antiretroviral therapy
• 8700 [7600–11 000] people became newly infected with HIV
• 15 000 [12 000–17 000] people died from AIDS-related illnesses

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.

Action-based partnership to support women and girls announced by health and political leaders at a high-level event at the 73rd Session of the United Nations General Assembly

GENEVA, 24 September 2018—UNAIDS, the Chair of the H6 partnership (six United Nations bodies working on health-related issues), and the African Union have pledged to enhance their collaboration to eliminate sexual and gender-based violence, prevent HIV and protect women’s health and rights in humanitarian settings.

A new programme of work on this common agenda was announced at a special high-level event held in New York, United States of America, on the margins of the 73rd Session of the United Nations General Assembly.

“We are gathered here to coordinate our efforts among the African Union and the United Nations to plan and intervene so that people's rights are protected, HIV is prevented and the right to health is promoted,” said Faustin-Archange Touadéra, the President of the Central African Republic, who chaired the meeting.

The rise in the frequency and scale of humanitarian crises is having a devastating impact, particularly on women and children. In 2017, around 68 million people were forcibly displaced globally as a result of persecution, conflict or generalized violence—an increase of 2.9 million from 2016 and a new record high.

“We know that it is time to act. More than 2 billion people live in countries affected by fragility, violence and conflict—most are women and girls. This is unacceptable. We need political visibility and intensified international cooperation to eliminate gender-based violence and protect the health of women and children in humanitarian settings,” said Michel Sidibé, Executive Director of UNAIDS and H6 Chair.

UNAIDS will support the African Union in developing a joint African Union–United Nations plan of action. The plan will include developing training and awareness tools for uniformed personnel in peacekeeping operations and ensuring better reporting rates on sexual exploitation and violence against women and girls.

“The partnership between the United Nations and the African Union provides an opportunity to reinforce each other’s work and employ joint and comprehensive responses to the needs of vulnerable populations in crisis situations,” said Smail Chergui, African Union Commissioner for Peace and Security.

Protecting the health and rights of women and young people will be critical to mitigating fragility, conflict and disaster. It is estimated that 60% of all preventable maternal deaths occur in humanitarian and conflict settings, which equates to nearly 500 deaths each day.

“In South Sudan, 52% of our young sisters are married before their 18th birthday. I urge leaders not to remain loudly quiet. We call for the inclusion of women in political processes. It is our bodies, our lives and our futures at stake. We have the right to the highest attainable standard of health, whether in conflict or not,” said Riya William Yuyada, Executive Director, Crown the Woman, South Sudan.

There are currently too few successful programmes to prevent gender-based violence during conflict and against refugee populations. Studies have shown that violence against women and girls increases during periods of conflict, with rape and other forms of sexual violence often being a common practice of war.

“It’s not about silencing the guns, we must recognize that women and children have a right to life and a right to health and a right to peace. This is where we should put our energies and time to make sure women and girls are protected,” said Bience Gawanas, the United Nations Secretary-General’s Special Adviser on Africa.

The United Nations’ 2030 Agenda for Sustainable Development and the African Union’s Agenda 2063 have created an important political window. The new commitments provide a timely opportunity to enhance collaboration on human security and humanitarian health, in the context of the recently adopted Joint United Nations–African Union Framework for Enhanced Partnership in Peace and Security.

“We must not explain why we are partnering, but why we are not partnering to eliminate sexual and gender-based violence and protect the health and rights of women and children in humanitarian settings. If we care about addressing the root causes of deprivation and poverty and abuse, women and girls are the heart of the matter,” said Sigrid Kaag, Minister of Foreign Trade and Development Cooperation, Netherlands.

Among the commitments made by UNAIDS and the African Union is to work to ensure that there is adequate funding to strengthen coordinated programme implementation for the responses to sexual exploitation and abuse and HIV in humanitarian settings. This enhanced cooperation between the African Union and the United Nations will be paramount to ensuring sustainable people-centred peace, security and development.

For more information on the new partnership between UNAIDS and the African Union, go to unaids.org

ADDITIONAL QUOTES

Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy

It’s not just about the funds, it’s also about policies, laws and justice for girls and children, especially considering that 60% of the African continent is under 20 years old.

Elhadj As Sy, Secretary-General, International Federation of Red Cross and Red Crescent Societies

They need peace, they cry for peace, yearn for hope and try to retain the human dignity that they have lost along the way. It is the last piece of cloth, as we say in Africa, that is torn apart by gender- and sexual-based violence. Protection should not come as an afterthought.

Michaëlle Jean, Secretary-General, Organisation internationale de la Francophonie

Violence, rape, assault against women and young girls and boys is worldwide and can be likened to a weapon of mass destruction. We are here to do more against all forms of discrimination and crimes committed against women.

Pramilla Patten, Special Representative of the United Nations Secretary-General on Sexual Violence in Conflict

Shame, stigma and the risk of reprisals and lack of access to services lead to chronic underreporting. By isolating victims and cutting them off from medical care and support, stigma facilitates the spread of HIV.

Armed conflict creates conditions that allow HIV to flourish, including through rape, sexual slavery, and trafficking and exploitation, in environments where the rule of law and public health services may have collapsed.

Bintou Keita, United Nations Assistant Secretary-General for Peacekeeping Operations

Female peacekeepers are now being deployed to facilitate dialogue as well as women protection advisers for a more comprehensive approach to peacekeeping. Peacekeepers are also the ones who provide civilian peace and security, men and women who are committed to provide the best peace they can.

Lorena Castillo de Varela, First Lady of Panama

Since I started this journey with UNAIDS and the United Nations, two powerful words have guided me: zero discrimination. The challenges faced by women and children—particularly in humanitarian settings—are fuelled by stigma and discrimination, creating obstacles that block access to vital health services, such as HIV testing and life-saving medicines. Zero discrimination should fill every space in the world.

Martine Moise, First Lady of Haiti

Haiti has known its fair share of natural catastrophes, from earthquakes to hurricanes, making women and girls particularly vulnerable. In Haiti, gender-based violence is also all too common. I support fully the fight against violence against women and gender-based violence. This is a fight that must involve all.

Laure-Marie Kitanu, Coordinator of the Network of Women Living with HIV, Democratic Republic of the Congo

We have cried out to the international community for help in regard to HIV testing and prevention and we implore you to maintain the priority of peace and stability so that we have a long-lasting solution. We commend this African Union and UNAIDS initiative.

Written contribution from Ashraf El Nour, Director, International Organization of Migration Office to the United Nations, New York

The International Organization of Migration calls upon African Union governments and partners to ensure the fulfilment of the right to health for migrants, regardless of their status, in order to enhance the resilience of populations living in vulnerable conditions. The failure to do so not only jeopardizes the public health safety of vulnerable groups, but also that of entire communities where they reside.

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.

Mother of five Regina Mateo shows us her home in Wau, South Sudan—a temporary shelter at the protection of civilians (POC) refugee site. She brought her family here to seek refuge from violence and instability in her village. However, Ms Mateo and her family are eager to return home as soon as it is safe to leave.

Everyone wants a safe place to call home. But, with conflict and violence ongoing throughout much of the country, that is too much to ask for many in South Sudan at the moment. The Wau POC holds a population of 20 880 people, but there are many other sites offering refuge. In Juba, the POC holds 39 405, in Bentiu 116 725, in Malakal 24 417 and in Bor 2296. Many people leave the POCs during the day to work but return at night from fear of violence at the hands of armed groups.

During his recent visit to Wau, UNAIDS Executive Director Michel Sidibé was welcomed by a network of women and girls living with HIV and representatives of service providers from the United Nations family and local government. He said, “With the collapse of health infrastructure and upheaval of entire communities in conflict zones, continuity of treatment and care has become difficult in the extreme. But the people of South Sudan are resilient. And this brings us hope.”

Mr Sidibé visited the Wau POC to better understand the living conditions of people who have been displaced as well as the services available to them. Living conditions are difficult, with limited basic services. Everyone is desperate for peace so that they can return home.

Despite these challenging circumstances, the United Nations family is working together to deliver basic services. A highlight is the delivery and stabilization units in health facilities supported by the International Organization for Migration and the United Nations Population Fund that serve both the people who have been displaced and the host community and which integrate HIV services as part of broader primary health-care services.

Survivors of gender-based violence are also able to access psychosocial support and clinical management of rape services. These services are available in part thanks to UNAIDS resources complementing resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Mr Sidibé met with the Governor of Wau, Angelo Taban, and, together with the State Minister of Health, they visited the Wau Teaching Hospital, where they met peer mentor mothers who are living with HIV but who have given birth to HIV-negative babies. The health personnel are doing tremendous work despite the tough working conditions.  

At the Juba Teaching Hospital, the South Sudan Network of People Living with HIV described the critical challenges many people are facing. “Many people living with HIV are lost to follow-up, due to the current crisis. Many of them are in the South Sudan bush, many others are on the move to neighbouring countries without medication. Those in towns are dying in silence due to poverty.” But hope is alive. A whole new generation of midwives are being trained, making real the right to health and non-discrimination in health facilities.

Despite all the challenges, from conflict to a collapsing health infrastructure, insufficient funds and unmet basic needs, the people of South Sudan are resilient.