The HIV epidemic continues to have a profound humanitarian and public health impact in western and central Africa, a region that risks being left behind in the global response to ending the AIDS epidemic. In July 2017, the African Union endorsed a regional catch-up plan for western and central Africa that seeks to rapidly accelerate access to HIV treatment and close the gap between African regions. National catch-up plans have been established in 18 countries in western and central Africa, including in Liberia.

It is estimated that in 2017, 40 000 people were living with HIV in Liberia, including around 3000 children aged 0–14 years. Fewer than one in three adults aged 15–49 years who are living with HIV have access to medicines that would keep them well and stop them passing on the virus to other people. For children, the situation is even more challenging, with just 18% on treatment.

However, there are encouraging signs that Liberia is scaling up its response to the HIV epidemic and adopting best practice programmes and policies to ensure the delivery and take-up of HIV testing, treatment and prevention services. Under the leadership of the Ministry of Health and the National AIDS Commission of Liberia, a Fast-Track plan for 2019–2020 has been developed that identifies high-impact programmes to accelerate the response, the urgent need for adjustments to existing programmes and barriers that must be removed in order to ensure better service delivery. It also recognizes that prevention measures must be reinforced and that stigma and discrimination associated with the virus must be reduced.

The Liberia catch-up plan seeks to triple the country’s test and treat figures, whereby people who test positive for HIV are immediately referred for treatment. The catch-up plan is guided by a location–population approach, with a service delivery bias towards the three counties with the highest unmet need for HIV testing, treatment and care services, urban areas and some other locations. Services are oriented towards adults aged 15–49 years, especially to pregnant women and to groups at higher risk, such as gay men and other men who have sex with men, sex workers, people who inject drugs, prisoners and mine workers. Infants exposed to the virus during pregnancy and breastfeeding are also a priority.

The plan also aims to tackle the low take-up of services by men.   

“We are designing interventions that will encourage more men to test and know their status. Of those tested so far, 80% are women,” said the National AIDS Commission of Liberia Chair, Theodosia Kolle. “Stigma remains a major issue in Liberia.”

UNAIDS played a significant role in helping to draft the catch-up plan, mobilizing stakeholder involvement and ensuring that people living with HIV, civil society and members of key populations were included in order to shape its design. Around 70 people took part in a special two-day workshop in March to craft the necessary political and programmatic measures to improve service delivery, enhance community mobilization, increase funding and enable a more efficient use of existing resources and an improved monitoring and evaluation system.

The workshop was also an opportunity to validate the Global AIDS Monitoring (GAM) report for 2019 for Liberia. GAM is the world’s most extensive data collection on HIV epidemiology, programme coverage and finance and publishes the most authoritative and up-to-date information on the HIV epidemic—vital for an effective AIDS response.

“With teamwork we can reach the 2020 Fast-Track Targets as long as we prioritize and implement high-impact programmes,” said Miriam Chipimo, UNAIDS Country Director for Liberia.

The 90–90–90 targets included in the Fast-Track approach are that, by 2020, 90% of all people living with HIV will know their status, 90% of all people living with HIV will have access to antiretroviral therapy and 90% of all people on antiretroviral therapy will have viral suppression.

For five weeks in 2018, teams of up to 10 people in each of 120 clinics and hospitals across Lesotho sifted through more than 180 000 records of people diagnosed with HIV and receiving care. The goal: to count the number of people living with HIV who were on treatment in June 2018.

During the long and dusty days, the teams attached green stickers—indicating active on treatment—or other coloured stickers—specifying that a person had defaulted, transferred or died—to nearly 80% of all patient files in the country. Facility by facility, counts of the number of people found to be active on treatment were compared to counts previously reported to the Lesotho Ministry of Health and other partners, including the United States President’s Emergency Plan for AIDS Relief. All of this to confirm that the country’s reporting adds up.

“Together with our team, we reviewed the treatment status of more than 5000 people at the Senkatana Clinic in Maseru, Lesotho, one of the oldest and busiest treatment centres in the country. After two days of reviewing the paper-based files, we found about 30% more people on treatment than the clinic had reported to the Ministry of Health in June 2018,” said Motselisi Lehloma, Ministry of Health Officer. Overall, the exercise found an underreporting to the Ministry of Health of 3% for all the 120 facilities visited.

Since early 2017, UNAIDS and other international partners have supported more than 15 countries, primarily in sub-Saharan Africa, to verify that the number of people reported currently to be on treatment is accurate. This work also supports facilities to improve the accuracy of the data reported through their health information systems by reviewing patient registries and processes for collecting, aggregating and reporting treatment numbers.

“The exercise that Lesotho undertook to audit and validate treatment numbers underscores its commitment to accurately monitor programme impact,” said Kim Marsh, Senior Adviser, Epidemiology and Monitoring, UNAIDS. Thanks to these efforts, and the efforts of many other countries in the region, UNAIDS and stakeholders can be confident in treatment numbers that allow us to monitor progress towards 90–90–90. Through debriefings with clinical staff and written reports, minor deficiencies were addressed on the spot and larger systematic issues were brought to the attention of the ministry and implementing partners in order for them to adopt necessary corrective actions.

Lesotho has one of the highest burdens of HIV in the world. In 2017, 320 000 people were living with HIV in the country, an HIV prevalence of 23.8%.

Ahead of its 43rd meeting in December, the UNAIDS Programme Coordinating Board (PCB) conducted a four-day visit to South Africa between 15 and 18 October. During the visit, the delegates met with a wide range of national and development partners working on the AIDS response and conducted a number of site visits in order to experience the support of the Joint Programme to the national AIDS response in a high-burden country.

South Africa has the largest HIV epidemic in the world, with 7.2 million people living with HIV. In the past 10 years, it has made significant progress in its AIDS response, with 4.4 million people living with HIV on treatment. The country also invests heavily, with approximately 75% of the response funded by the government—just over US$ 2 billion in 2017. However, new HIV infections are high, at 270 000 in 2017.

The PCB delegation, led by the UNAIDS Deputy Executive Director, Gunilla Carlsson, and Danny Graymore, from the United Kingdom of Great Britain and Northern Ireland, the Chair of the PCB, comprised seven representatives of Member States, one civil society representative and a number of participants from the Joint Programme.

“The strength of the UNAIDS Programme Coordinating Board is its unique multistakeholder representation, which includes civil society and United Nations cosponsoring organizations, in addition to Member States,” said Mr Graymore. “The United Kingdom has put a particular focus on prevention for 2019. Coming to South Africa, we wanted to see how to get better results on HIV prevention in the context of a conducive environment and a significant investment in the national response.”

During a meeting with the South African National AIDS Council’s (SANAC) civil society forum, Valeria Rachinska, a PCB delegate from civil society, encouraged members of civil society in South Africa to use their voice in the UNAIDS PCB through the two African region representatives.

“The UNAIDS Programme Coordinating Board is unique in that civil society are members and our voice is heard. We can influence the global agenda in this way. I encourage you to get in touch with your African representatives and make your voices heard,” she said in response to concerns about the financing and sustainability of civil society organizations in South Africa.

During the visit, PCB delegates met with other representatives of SANAC, national and local government, civil society and the private sector and visited community-based initiatives in the KwaZulu-Natal and Gauteng Provinces.

“I am delighted to visit South Africa with such a broad and knowledgeable Programme Coordinating Board delegation. It is clear that the support of the Joint Programme is appreciated and important. We need to focus more on HIV prevention and ensure that we reach people being left behind by the AIDS response and find ways to deliver effective prevention services for young women and adolescent girls,” said Ms Carlsson.

UNAIDS’ unwavering commitment praised by the President

GENEVA, 25 October 2018—The President of Botswana, Mokgweetsi E.K. Masisi, visited UNAIDS headquarters in Geneva, Switzerland, on 25 October 2018 to share Botswana’s vision on a key public health concern: HIV.

The President met the Executive Director of UNAIDS, Michel Sidibé, and congratulated UNAIDS for leading the AIDS agenda with humility and professionalism. 

“We continue to count on your stewardship,” said Mr Masisi. “Botswana stands ready to sprint the last mile to end AIDS as a public health threat.”

Two decades ago, AIDS ravaged the small southern African nation of 2 million. Today, despite having one of the highest rates of HIV in the world – 23% of adults live with HIV- Botswana has shown remarkable progress. New HIV infections have been reduced by 63% since the peak in 1996 and AIDS-related deaths have decreased to 4100 from 15 000 in 2008. It was the first country in the region to provide universal, free antiretroviral treatment to people living with HIV, paving the way for many other countries in the region to follow.

Mr Sidibé described the President as an advocate for the region. “Mr Masisi is bringing new energy and impetus to the AIDS response in Botswana with a focus on HIV prevention,” said Mr Sidibé. The President participated in a moderated dialogue along with a high-level delegation that included the Minister of International Affairs and Cooperation and the Minister of Health and Wellbeing as well as the First Lady of Botswana. During the discussions, the President described Botswana’s financial investments in health, HIV and its people.  He highlighted that mother-to-child HIV transmission is on the verge of being eliminated and that more than 80% of people living with HIV are on treatment.

However, challenges remain. “When you disempower a young girl through violence or unwanted sexual experience, she is affected for life,” Mr Masisi said. In order to curtail new HIV infections, the President committed to redefining the roles and engagement of young boys and men. Mr Masisi and Mr Sidibé then recognized former President Festus Mogae’s long-standing efforts to turn the country around from despair to hope when Botswana faced the HIV crisis initially.  

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 Parliamentary Network to Fight AIDS, Tuberculosis and Malaria reaffirmed its commitment to increase funding to end the three diseases at its annual meeting in Lomé, Togo, held on 4 and 5 October. The network committed to urge the heads of state and government of the Francophonie to advocate for increased funding during the sixth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which will be held in Lyon, France, in October 2019.

“UNAIDS recognizes the important initiatives of French-speaking parliamentarians at both the national and international levels, as well as the advocacy and efforts of the Parliamentary Network to Fight AIDS, Tuberculosis and Malaria,” said Christian Mouala, UNAIDS Country Director for Togo.

The network, which is affiliated to the Parliamentary Assembly of the Organisation internationale de la Francophonie, also agreed that it will focus on the reform of punitive laws that perpetuate HIV- and tuberculosis-related stigma and discrimination.

“The responses to AIDS, tuberculosis and malaria require the commitment of all: national ministries of health, researchers, funders and, of course, parliamentarians. Only by pooling our efforts and with the strength of our parliaments and our members can we hope to, one day, overcome these epidemics,” said Didier Berberat, President of the Network to Fight AIDS, Tuberculosis and Malaria and Councillor for States, Switzerland.

UNAIDS has a cooperation agreement with the Parliamentary Assembly of the Organisation internationale de la Francophonie, which is due to be renegotiated this year.

In South Sudan, 7 million people are in need of humanitarian assistance and 5 million people need access to health services, including HIV prevention and treatment services. In this context, AIDS does not stand in isolation; rather, it is an entry point for social transformation. This was the message of Michel Sidibé, UNAIDS Executive Director, during his recent visit to the country.

“We all know the challenges that South Sudan is facing. But during this visit I have been humbled and impressed. I have seen that, despite challenges, when people on the ground are committed, anything is possible,” said Mr Sidibé.

While in South Sudan, Mr Sidibé signed a memorandum of understanding on the right to health in the education sector with the Ministry of Health, the Ministry of Education and Instruction and the South Sudan AIDS Commission. The agreement commits all parties to develop and implement a strategy in line with the UNAIDS Fast-Track approach and the Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People in Eastern and Southern African, of which South Sudan is a signatory. 

In 2016, an estimated 200 000 people were living with HIV in South Sudan. In addition, only 10% of people living with HIV were accessing life-saving HIV treatment. Children are particularly vulnerable, with fewer than 1000 children living with HIV between the ages of 0 and 14 years on HIV treatment—5% of those in need.

To accelerate results in the AIDS response, James Wani Igga, the Vice-President of South Sudan, in the presence of Mr Sidibé, launched the 2018–2022 South Sudan National Strategic Plan on HIV and AIDS, which will provide a solid monitoring and evaluation framework for the implementation of the national AIDS response.

“Stigma often leads to discrimination and other violations of human rights that affect the well-being of people living with HIV. HIV-related stigma is compounded for those individuals who identify with already stigmatized groups, including sex workers and men who have sex with men,” said Mr Igga.

Mr Sidibé also discussed with Mr Igga how more can be done together to address HIV in South Sudan, with a particular focus on HIV among uniformed personnel as a key entry point. They discussed how the AIDS response can build resilience, protect rights and promote freedom from violence, peace and stability in South Sudan.

Parliamentarians from across Africa are considering a historic resolution to promote the right to health and achieve targets on HIV, tuberculosis, malaria and other health emergencies, such as cervical cancer and hepatitis.

Michel Sidibé, the UNAIDS Executive Director, addressed the Pan African Parliament on 9 May to urge its members to express their firm commitment and determination to end the AIDS epidemic and deliver on the Abuja Declaration and the plan of action on achieving health targets in Africa. The plan of action resulted from a high-level parliamentary meeting convened in October 2017 by UNAIDS in partnership with the Pan African Parliament and the African Union.

“A Pan African Parliament resolution will help to achieve health targets in Africa. Parliamentarians, as champions in their communities, can help achieve these targets,” said Mr Sidibé.

The final decision of the parliament will be confirmed after the sixth ordinary session of the fourth parliament concludes on 18 May. The resolution will be the first of its kind for the Pan African Parliament since it commenced in 2004.

“AIDS is not over. We need to reach everyone who does not yet know that they are HIV-positive,” said Kgalema Motlanthe, former President of South Africa.

Population growth and fast urbanization, fuelled by sustained immigration and accelerating mobility, are rapidly changing the socioeconomic and behavioural patterns of people in big cities.

Mumbai, a city of 12 million people, was one of the first cities to sign up to the Fast-Track cities initiative, launched in Paris on World AIDS Day 2014. Since then it has rapidly adopted measures to accelerate progress towards achieving the Fast-Track 90-90-90 treatment targets. However, the challenge today goes beyond scaling-up efforts to attain the 90-90-90 targets. Efforts to end AIDS must also focus on effective use of combination HIV prevention and eliminating the stigma and discrimination that impede universal access to health services.

The Mumbai District AIDS Control Society and UNAIDS brought together more than sixty participants from government, international and civil society organizations from 10 to11 April to identify innovative strategies to expand HIV prevention and treatment service coverage in the megacity.  

Participants noted that growing inequalities in the urban environment were forcing people to take risks to survive. Sex workers, people who inject drugs, men who have sex with men and transgender people (Hijras) who are already at higher risk of HIV infection are particularly negatively impacted by these trends.

Urban gentrification is pushing key populations out of areas where they had previously gathered making the task of delivering HIV services more complicated. As populations have become more dispersed and hidden, traditional HIV prevention outreach approaches using peer workers have become less effective.

Reflecting on these challenges, participants noted that with change came opportunity. More systematic compilation of data and granular analysis has helped identify locations and populations where risk and vulnerability are greatest. According to city officials, improved data and understanding is helping to refine their approach to HIV prevention interventions. New packages of services designed through the profiling of newly emerging risk behaviours are being planned.

To further Fast-Track the AIDS response, several new approaches have been introduced. Community-based HIV screening helps to accelerate diagnosis and treatment of people living with HIV.  Similarly, in growing slum areas mobile vans offering HIV testing services provide the opportunity to large numbers of people to know their HIV status.

While social media platforms are proving a cost-effective means to improve HIV awareness and connect people to prevention and treatment services, Mumbai authorities are convinced that more innovative communication strategies are also necessary. They plan to use social and mass communication media to mobilize support to ‘normalize’ AIDS as a chronic disease and prevent new HIV infections. HIV champions will target a range of different audiences including adolescents and young people to amplify HIV prevention messages.

All participants agreed that efforts to scale up access to HIV services need to be led at a faster pace as “there is no time to lose” to end AIDS by 2030.

Côte d’Ivoire has become the first francophone country, and the first in western and central Africa, to launch an HIV situation room, a software platform designed to support informed decision-making.

This innovative tool strengthens national information systems through real-time visualization of information from multiple data sets. It will enable leaders and programme managers to make timely decisions to improve health programmes to achieve the 90–90–90 targets, whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads, by 2020.

The situation room is the result of a collaboration between the Côte d’Ivoire Ministry of Health and Public Hygiene, the United States President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention, and UNAIDS. It was launched by Raymonde Goudou Coffie, the Minister of Health and Public Hygiene of Côte d’Ivoire, and Michel Sidibé, Executive Director of UNAIDS, on 26 March in Abidjan.

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On International Women’s Day, which is celebrated on 8 March every year, Yosweri Museveni, President of Uganda, affirmed his commitment to empower women in the work place and in the domestic sphere. At an International Women’s Day celebration in Mityana District, in the Central Region of Uganda, President Museveni outlined the action taken by government to promote women in the civil service, including the army, police and in Parliament. Government is also currently developing legislation to promote the rights of women in the home.

During the event the President, in the presence of UNAIDS Executive Director, Michel Sidibé, launched the Presidential Fast-Track Situation Room, a data visualisation platform which draws from multiple sources to provide real-time data for monitoring the implementation of the Presidential Fast-Track Initiative to End AIDS in Uganda by 2030. The initiative is a multi-sectoral effort to consolidate progress on key areas of HIV prevention revitalize HIV prevention, testing and treatment.

In a special ceremony, the President awarded Mr Sidibé the Most Excellent Order of the Pearl of Africa, the highest civilian award of the Ugandan Honours System, in recognition of Mr Sidibé’s contribution to the global AIDS response and his continued support to the Government of Uganda and its partners.

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