Holy Disrupters: Interviews with religious leaders and advocates on HIV and compassion

Thabo Makgoba, Archbishop of Cape Town

UNAIDS speaks to the Archbishop of Cape Town, Thabo Makgoba about his work on HIV and his hopes for the future

What was your experience working on HIV in the early days?

I first started working on HIV in around 1998 when I was a rector in Johannesburg and it was a scary time, I remember the South African television adverts saying ‘AIDS kills’ with a coffin that banged—we were all terrified. Everyone was scared, there was a lot of stigma, parishioners were also dying from fear and lack of knowledge.

"There was an immense fear that life had come to an end…."

Through Archbishop Desmond Tutu and others we knocked on every door and established the Anglican Church of Southern Africa’s AIDS programme called ACSA. We hit the ground running but there was an immense fear that life had come to an end….

How has your work changed today?

Today our work has evolved—from fundraising, to incorporating HIV messages in the liturgy, in the prayers and in the readings. Today we make sure we don’t work in silos, we work with the mining companies, with the other churches and we work from an interfaith context—challenging our governments to do the right thing.

Much has happened in recent years and things have changed. There’s a sense of trust that has developed and partnerships now are much easier. As leaders, we have learned to work together, we’ve learned to work together on the ground, but we’ve also learned to work with our international partners. I’m hugely grateful to PEPFAR. Initially there was a degree of suspicion but once we realized, through UNAIDS, that PEPFAR is there to help us check our own resources and to strengthen our resolve to help people – a great deal of trust has been developed.

“There is nothing more pro-life than PEPFAR.”

I pray that PEPFAR will be reauthorized to ensure that the commitments that we have made are realized. There is nothing more pro-life than PEPFAR. Millions of mothers and children have been saved from dying because of PEPFAR.

UNAIDS has also been essential. UNAIDS has showed us how important numbers and record keeping are, how important data is. We have to be systematic, we have to be thorough in our interventions, understanding that evidence-based interventions are critical.

“UNAIDS has showed us how important numbers and record keeping are, how important data is.”

In faith communities you can drown in the tsunami of problems, you throw yourself into your work without really knowing whether the intervention is working. But through praying, partnering with others, looking at the numbers and seeing the impact on people whose viral load has been reduced has been a great experience—we have learned a lot through working with UNAIDS and PEPFAR.

What does the faith community bring to the response to HIV?

It’s the fact that we are there. We are in every corner, even where governments can’t reach with their 4x4’s we have a little church there, we have a mosque there, we see God’s people every Sunday at the very minimum. We marry we bury we baptize, and we do this work not because we want to be paid or we want constituencies, it is our vocation and our calling.

“We marry we bury we baptize….We are in every corner, even where governments can’t reach with their 4x4’s”

Whether you are a Christian, Muslim, a Jew or a non-believer, you are a child of God and you need healing. We don’t exist for ourselves, we exist in order to show the love and care of God in the communities.

“We smile at you so please smile at us, because together we have made this possible.”

We must ensure that no more children are born with HIV, we must work together to ensure that every child living with HIV has immediate access to treatment and we must ensure that those children will be alive and thrive. That way in 2025 they will come here saying “you have allowed us to live, and we smile at you so please smile at us, because together we have made this possible.”

With just two years left to attain the 2025 HIV prevention target of fewer than 370 000 new HIV infections annually, the world is not on track. In 2022, 1.3 million people became infected with HIV – the urgency to accelerate progress cannot be overemphasized. The Global HIV Prevention Coalition co-convened by UNAIDS and UNFPA ensures a strengthened and sustained political commitment for primary prevention across key policy makers and programme implementers. It includes countries such as Botswana, Cameroon, Eswatini, Lesotho, Malawi, Rwanda South Africa, and Zimbabwe – which have reduced new HIV infections by more than 70% since 2010.  

However, there were disparities across populations and regions. No significant declines were seen among key populations (sex workers, men who have sex with men and people who inject drugs).

Globally, 4,000 new HIV infections occurred among adolescent girls and young women aged 15-24 years, every week – 3,000 of these occurred in Sub-Saharan Africa. Approaches and investments for HIV prevention are currently insufficient to meet global targets.

The directors of National AIDS Coordinating Agencies, Ministry of Health HIV leads from the Global HIV Prevention Coalition focus countries and development partners were convened by the HIV Prevention Leadership Forum, with support from UNAIDS and UNFPA, to reinforce their commitment to stopping new HIV infections. This is part of efforts to ensure effective implementation of expanded HIV programmes with a focus on key and priority populations .

During the meeting, each country identified commitments  that they will drive and will be held accountable for in 2024 as well as technical level actions necessary for programme optimization.  Donors and global technical partners identified opportunities for technical and financial resources available at country level to supplement national resources to drive the action plans. 

The first lady of Namibia and UNAIDS Special Advocate for Adolescent Girls, and Young Women, Her Excellency Monica Geingos urged the country leaders in the HIV response to adapt solutions tailored to their national needs culturally, socio-economically, and politically. Whilst strengthening global collaboration, leaders should strengthen partnerships across sectors within the countries. Success in HIV prevention is possible, however, not only does it require leadership at government level, but also communities must lead.

The Global Prevention Coalition co-chair and former Minister of Health of Botswana, Prof. Sheila Tlou encouraged government leaders to follow the science, make data-driven decisions and ensure community leadership and participation in HIV prevention programming. This will secure gains made, bridge disparities and expedite progress needed for success in HIV prevention.

Dr Ruth Laibon Masha, Co-Chair of the HIV Multi-Sector Leadership Forum and Director, National Syndemic Disease Control Council, underscored the need to secure gains made by extraordinary leaders from multiple sectors who have played a crucial role in advancing the HIV movement and achieving significant progress. “By continuing to lead from the front we can work together towards the goal of delivering a future free of new HIV infections and AIDS-related deaths. It’s time to recommit and finish the race against time “, she added.

Vice Minister, National Disease Control and Prevention Administration (NDCPA) affirmed China’s commitment towards strengthened multisectoral leadership and promotion of a nationally led HIV prevention and health agenda.

Quotes

In 2022, the Indian Supreme Court ruled that sex workers were covered by Article 21 of the Constitution which assures every person the right to life. It recognized that sex workers are entitled to equal protection under the law.

The court instructed both central and state governments that sex workers should not be arrested, penalised, harassed or victimised during brothel raids. (Running a brothel is illegal in India. Individual sex work is not.) Nor should the possession of condoms and other safer sex commodities be treated as evidence of an offence. And the police should be sensitised to the community’s rights.

Moreover, the court also stressed the vital need to uphold the basic protection of human decency for the children of sex workers who, “bearing the brunt of social stigma… are removed to the fringes of the society, deprived of their right to live with dignity”. This ruling will help ensure that the children of sex workers can access essential services, including healthcare and education.

To commemorate this landmark judgment, the All-India Network of Sex Workers (AINSW) conducted a three-day National Consultation titled ‘Sisterhood and Solidarity with Sex Workers: One Year Since the Historic Supreme Court Ruling of 2022’. AINSW has been working on the issues of sex worker rights since 2011 across several states.

“Laws make a difference,” said David Bridger, UNAIDS Country Director to India in his keynote address. “The Supreme Court ruling was historic because with this, India joins a handful of countries like Canada and New Zealand that have explicitly instituted legal protection for sex workers. Recognizing the equal worth and dignity of every person is not only ethical, but also critical for ending AIDS.” 

While giving an overview of the Supreme Court ruling, Senior Advocate, Anand Grover, noted that sex workers have taken steps which have contributed to the decline of HIV in India by negotiating condom use with their clients.  A 2021 study found that 98% of sex workers used condoms. The work to educate and empower this community to have safer sex is paying off. HIV prevalence among female sex workers is now just under 2%. Protecting the safety and human rights of key populations expands their access to HIV services, accelerating progress in the response to HIV.

Mr Grover called for a full understanding of the law and how it impacts the lives of sex workers. He also stressed the importance of community participation in law and policy development, noting that the Court itself called for sex workers to be involved in decision-making processes linked to issues which affect them.

Shyamala Natraj, Executive Director of the South India AIDS Action Programme (SIAAP), briefed the audience about what went into making the 2022 ruling possible. She said the judgment was the result of strategic and consistent advocacy which centred on the lived experiences of sex workers.

In 2020, for example, the National Human Rights Commission issued an advisory recognising sex workers as entitled to the same social protection as other informal workers for the first time. Sex workers had been among the hardest hit during the COVID-19 pandemic. Not only did they experience an abrupt loss of income, but some were excluded from state social safety net responses. The fallout was extreme, including hunger, homelessness, debt, depression, and even suicide.

The SIAAP shared an example from Usha Ram (not her real name) from the town of Theni: “I did not have money to pay rent. The house owner forced me to vacate and humiliated me in front of my neighbours for doing sex work. I was on the streets with my children and did not even get the advance back.”  

Ms Natraj encouraged the community to assert their human rights and secure access to the services that would ordinarily be provided to them under the law, including the issue of Aadhar (identification) cards, rations, poverty alleviation support and proof of residence documentation.

But despite the Supreme Court’s ruling that “sex work is a profession” with the same human rights as others, and that sex workers should not be harassed by the police, inequalities, stigma, and discrimination persist. Many sex workers are still reporting police harassment; some say they are still charged for soliciting clients.

To safeguard the human rights of sex workers, experts reiterated the need to implement the Supreme Court judgment at the grassroots level. UNAIDS and its cosponsors are committed to working with communities, policy makers and law enforcement to increase awareness and to ensure the universal upholding of sex workers’ human rights. 

This will speed up progress to end the AIDS pandemic and save lives.

GENEVA, 4 October 2023—The United Nations in Mauritius—which includes UNAIDS, UNFPA, OHCHR, UNDP and WHO—welcome today’s ruling by the Supreme Court of Mauritius that a discriminatory law criminalizing consensual same sex relations is unconstitutional and will be immediately struck from the legal code. Previously, under Section 250 of the Mauritian Criminal Code (which dated back to 1898) anyone convicted could have faced up to five years in prison.

“The Supreme Court today overturned an obsolete colonial law and demonstrated its commitment to non-discrimination and leaving no-one behind,” said Lisa Singh, United Nations Resident Coordinator in Mauritius. “The UN in Mauritius and internationally welcomes the decision of Mauritius to join the growing list of African countries protecting the human rights of everyone, including LGBTQI+ people.”

The ruling noted that “Section 250 was not introduced in Mauritius to reflect any indigenous Mauritian values but was inherited as part of our colonial history from Britain. Its enactment was not the expression of domestic democratic will, but was a course imposed on Mauritius and other colonies by British rule.” It also noted that a growing number of countries have decriminalized consensual same sex sexual relations, including the United Kingdom which overturned its law in 1967. 

“Mauritius' decision to decriminalize homosexuality is an important step forward for public health and a step towards equal rights, respect and dignity for the LGBTQI community,” said Anne Githuku-Shongwe, Director of UNAIDS’ Regional Support Team for Eastern and Southern Africa. “UNAIDS applauds Mauritius for today’s decision which will mean that men who have sex with men will have much easier access to the health and social services they need without fear of arrest or criminalization. Work will need to continue to break down the barriers of stigma and discrimination towards the LGBTQI community, but today’s ruling is a positive step in the right direction. It will save lives.”

Mauritius becomes the latest in a growing list of countries to declare that laws which have criminalized LGBTQI people are unconstitutional. However, UNAIDS estimates that 66 countries still have laws which criminalize consensual same sex relations. In addition to contravening the human rights of LGBTQI people, these laws impede access to health and social services, including HIV services. Such laws fuel stigma and discrimination against LGBTQI people and put them under constant fear of being punished or detained.

The case was brought forward by Abdool Ridwan Firaas Ah Seek, President of Arc-en-Ciel, the largest and longest-standing organisation in Mauritius championing the human rights of LGBTQI people, and was supported by partners including the Human Dignity Trust.

Civil society organizations, especially community-led organizations, are at the forefront of a global wave of progress that advances access to health for all. UNAIDS urges all countries to decriminalise same sex sexual relations. Decriminalization saves and changes lives.

Maneesh Gobin, Attorney General and Minister of Foreign Affairs and Regional Integration in Mauritius said, “In keeping with its internationally acclaimed respect for the rule of law, Mauritius will indeed report to United Nations Member States at the next cycle of the Universal Periodic Review.” The Universal Periodic Review is a unique mechanism of the Human Rights Council that calls for each UN Member State to undergo a peer review of its human rights records every 4.5 years.

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.

Colombia makes landmark decision to declare the HIV medicine dolutegravir of public interest, allowing the country to purchase or manufacture more affordable, generic versions of the live-saving HIV medicine

BOGOTÁ/GENEVA, 4 October 2023—UNAIDS applauds the government of Colombia for declaring the HIV medicine dolutegravir of public interest. This important breakthrough in public health measures will allow the government to issue a compulsory license, breaking the monopoly, and making it much more affordable for the Colombian government to purchase or manufacture. The new decision could mean that the price of the life-saving medicine is reduced by as much as 80%.

“When the power to produce health technologies is held by a few companies, the result all too often is that countries can’t afford the high prices and people who need newer products cannot access them,” said Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “We are confident that this decision will have an impact across the whole region and beyond, as many middle-income countries are struggling to access generic markets of key health products to prevent and treat HIV infection.” 

The World Health Organization recommends dolutegravir as the preferred first-line and second-line HIV treatment for all populations. As well as being effective, treatments incorporating dolutegravir-based regimens have demonstrated greater adherence, due to fewer side effects, while presenting enhanced, safety, and reduced likelihood of drug resistance.

“This decision represents a milestone for public health in Colombia. Since the Ministry of Health initiated the administrative procedures earlier this year, over 120 civil society organizations, other government agencies, academia and international organizations including UNAIDS supported this process,” said Andrea Boccardi Vidarte, UNAIDS Director for the Andean Countries. "Through our local, regional and global offices, UNAIDS will continue supporting the government on the implementation of this landmark decision.” 

With this decision, the Colombian government estimates that it will be able to put 28 people on dolutegravir for the same price that it is allocated today to treat just one person. The implementation of the measure will allow the country to access less expensive, but just as effective, generic versions. A huge increase in reach with quality medicines which will save lives.

Colombia had already issued national guidelines in 2021 to prioritize dolutegravir as the recommended first-line antiretroviral treatment, in line with WHO recommendations. However, the high price of dolutegravir has remained an obstacle to expanding access and making it widely available to people living with HIV in the country.

This ruling will save lives in Colombia and across the region. The country hosts the largest number of Venezuelan migrants in the world (2.9 million as of October 2022). Recent studies have shown a 0.9% HIV prevalence among this migrant population, almost double the 0.5% HIV prevalence among the country’s adult population. 

“This decision provides the government with the legal conditions to manufacture or purchase more affordable versions of this essential first-line antiretroviral treatment for all people living with HIV in Colombia, including Venezuelan migrants”, said Ms Cabal.

Compulsory licensing is a provision in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement). It enables governments to supply its citizens with generic versions of patented treatments either through domestic production or imports, ensuring health products’ prices are affordable.

The 2001 WTO Declaration on the TRIPS agreement and public health reaffirmed the rights of member states to make use of all flexibilities in the TRIPS agreement to protect public health, including compulsory licenses. More recently, in the 2021 Political Declaration on HIV/AIDS, countries committed to make use of TRIPS flexibilities, specifically geared to promoting access to medicines.

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.

GENEVA, 29 September 2023—The topic of the global AIDS response—including its successes and invaluable lessons for handling pandemics—permeated many discussions during last week’s United Nations General Assembly (UNGA) in New York. From three High-Level meetings on health, to the Sustainable Development Goals (SDG) Summit to remarks given to the General Assembly and at High-Level Side events, the lessons from 40 years of responding to HIV—including the principle of leaving no one behind—were repeatedly referenced in the context of a future of health and equality for all.

In his remarks to the General Assembly, United States President Joe Biden referenced success against AIDS as a platinum example of what global solidarity and shared responsibility can achieve. “HIV/AIDS infections and deaths plummeted in no small part because of PEPFAR’s work in more than 55 countries, saving more than 25 million lives,” said President Biden. “It’s a profound testament to what we can achieve when we act together when we take on tough challenges and an admonition for us to urgently accelerate our progress so that no one is left behind.”

At the opening of the SDG Summit, Irish prime minister, Leo Eric Varadkar noted that half-way to the 2030 targets we are not where we would wish to be with only 15% of the SDGs on target. He added that despite this there is progress. “More than 800 million people have been connected to electricity since 2015, 146 countries have met or are on track to achieving the under-five mortality target, and effective HIV treatment has halved global AIDS-related deaths since 2010,” said Mr Varadkar. “This progress shows that change is possible, that backsliding is not inevitable, and that poverty, pollution and gender inequality are not pre-ordained. They are trends that can be reversed, problems that can be solved and tragedies that can be averted.”

While celebrating the collective success against AIDS, UNAIDS urged leaders to keep HIV high on political agendas for three reasons. “Firstly,” said Winnie Byanyima, Executive Director of UNAIDS, “The job is not yet done—43 years into the pandemic, there are still more than 9 million people waiting for life-saving treatment, more than 1.3 million new HIV infections every year and AIDS took a life every minute in 2022. Secondly: We know how to end AIDS and, we have the path and the power to do it. And thirdly: The AIDS response is a smart investment yielding other health, social and economic impacts.”  

A number of ministers and heads of state spoke about the economic challenges they face as the result of multiple and concurrent crises, and the need for cooperation and solidarity to overcome these crises while continuing to make critical investments in development and health. Many political leaders noted that while the political will is there, there are not enough domestic resources to invest in health, education and social protection.

The UN Secretary-General Antonio Guterres reminded the international community that there is an urgent need to rethink—and reconfigure--the international financial architecture in order to achieve the SDGs. The same is true for UNAIDS's mission to end AIDS as a public health threat and ensure those gains are sustained well beyond 2030. Ending AIDS requires new and sustained resources, and a different political discourse on funding for development. UNAIDS highlighted the importance for maintaining bilateral funding for PEPFAR and multilateral funding for the Global Fund to Fight AIDS, TB and Malaria.

UNAIDS stressed that as we develop a global architecture for pandemics prevention, preparedness and response, we need to draw from over 40 years of responding to AIDS, because the AIDS response is pandemic prevention, preparedness and response.

The importance of community-led responses as essential to reaching marginalized groups and people most affected by pandemics was emphasized. UNAIDS highlighted that the Pandemic Accord must acknowledge the central role of community-led responses and commit member states to include communities and civil society in decision-making, planning, preparation, implementation and monitoring. 

The call to end inequalities was a central theme to UNAIDS’ messaging at UNGA. UNAIDS highlighted the need for equitable, affordable access to life saving medical products and how inequality drives, and prolongs, pandemics. UNAIDS advocated metrics, targets and accountability systems for focusing the response and additionally for advancing human rights to improve public health and warned that human rights violations undermine trust and drive people away from health services.

Finally, UNAIDS called for a multisectoral/whole of society approach to effectively prevent, prepare for and respond to pandemics because pandemics are not merely health crises—they also present political, social and economic challenges which require transformative action by all.

The Executive Director of UNODC, Ms Ghada Waly, on behalf of UNAIDS’ cosponsoring organizations acknowledged that, “The multi-sectoral partnership on HIV/AIDS is as important as ever, bringing together the expertise, assets and comparative advantages of 11 Cosponsors in an exemplary partnership for the development approach of the SDGs.”

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.

UNAIDS’ Global AIDS Update The Path that Ends AIDS underscores 2 main challenges faced by voluntary medical male circumcision (VMMC) programmes: diminished funding and low coverage among men in their twenties and older. Since VMMC was recommended by WHO and UNAIDS in 2007 as key to HIV prevention in high-prevalence settings, about 35 million men have accessed services across the 15 VMMC priority countries. While this shows good progress, the Global AIDS update highlights that VMMC coverage remains far from reaching the 90% global coverage target for impact in many subnational areas of priority countries. Additionally, funding has declined by almost half since 2020 from approximately US dollars 285 million to US dollars 147 million for the 15 countries funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). But questions have arisen about VMMC’s cost-effectiveness under growing coverage of other biomedical interventions, such as antiretroviral treatment.

“We need strong political leadership to scale up implementation of VMMC programmes; tackle the inequalities holding back progress; and ensure sufficient and sustainable funding” said Angeli Achrekar, UNAIDS Deputy Executive Director of Programmes. “Countries that are putting people and communities first in their policies and programmes are already leading the world on the journey to ending AIDS by 2030.”

Voluntary medical male circumcision is a simple, safe procedure that has proven to reduce the risk of HIV transmission by up to 60% in heterosexual men. But is it cost effective? For how long must policy makers continue to promote VMMC among adolescent boys and adult men across VMMC priority countries? This is what a group of researchers investigated.

Now published in The Lancet Global Health and using 5 existing mathematical HIV models, the researchers aimed to assess whether providing VMMC for the next 5 years would continue to be a cost-effective use of HIV programme resources in sub-Saharan Africa. The models applied assumptions based on HIV epidemiology in VMMC priority countries focusing on Malawi, South Africa, and Zimbabwe. The impact and cost-effectiveness were projected over 50 years to capture clients’ lifetime HIV exposure and infection.

Findings reveal that a continuation of VMMC was cost-effective even in regions with low HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 1 per 100 person-years in men aged 15–49 years, increasing to 95% with HIV incidence greater than 10 per 100 person-years They underscored VMMC’s importance in continuing to avert HIV infections and related healthcare costs over time.

While details of the results varied by country and model (see Box1), overall VMMC was shown to be highly cost-effective and even cost saving in nearly all countries and scenarios.

The authors concluded that despite the scale-up of antiretroviral therapy and low HIV incidence in some settings, the continuation of VMMC for at least the next 5 years is cost-effective in almost all settings considered in this study.

“Clearly, intensified efforts and commitments are needed to scale up VMMC while at the same time sustaining these services to reach men and boys,'' said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes. “The new Global AIDS report shows a widening gap for men that is important to recognize and address efficiently and effectively for their own health and to reduce new infections.’’

These analyses support a call to action on intensified efforts to reach men and boys in general and for continued funding for VMMC programmes. The discussion on VMMC sustainability is crucial. UNAIDS and WHO are urging countries to intensify their efforts in scaling up VMMC to global coverage targets (90%), at the same time address programme sustainability.

In the 2025 HIV Prevention Roadmap, VMMC remains a core component of combination HIV prevention under the pillar of men and boys. It is not only cost-effective, but also, cost-saving in many settings. Accordingly, continued progress towards male circumcision coverage targets in all the VMMC priority countries must be accelerated

NEW YORK/GENEVA, 21 September 2023—UNAIDS has designated the First Lady of Botswana, Neo Jane Masisi, as a UNAIDS champion for the empowerment and engagement of adolescent girls and young women. UNAIDS Executive Director, Winnie Byanyima, confirmed the appointment during a meeting with Mrs Masisi during the 78^th session of the United Nations General Assembly in New York.

“Her Excellency Mrs Masisi has a deep understanding of the structural barriers that are making adolescent girls and young women so vulnerable to HIV infection in Botswana and right across Africa,” said UNAIDS Executive Director, Winnie Byanyima. “Mrs Masisi is a fierce advocate for the rights of young women and girls and for the need to support them to stay in school, finish their education and receive the knowledge they need to help them thrive.”

Mrs Masisi has already been working closely with UNAIDS for several years as an advocate for young people. In her new role, Mrs Masisi will champion Education Plus, an initiative launched by UNAIDS, UNESCO, UNICEF, UNFPA and UN Women to prevent HIV infections through free universal, quality secondary education for all girls and boys in Africa, reinforced through comprehensive empowerment programmes. Botswana joined the initiative in June.

In Botswana, young girls aged 15-19 years old are seven times more likely to become infected with HIV than their male counterparts. During the meeting the First Lady said that surveys showed that between 2015 and 2019 young women and girls accounted for 36% of all new infections in Botswana and 19 are boys and 43 girls become infected every week.    

“I will be serving with this special title at a crucial moment. The SDGs are just around the corner and it is the last sprint to end AIDS by 2030,” said Mrs Masisi. “We will be discussing some hard issues to protect our children and young people. But the good thing about our communities today is that they realise that these are not ordinary times, and they know that doors that were closed, mouths that were sealed—its time they were opened. I remain resolute in directing energies to supporting young people in my country.”

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.

NEW YORK/GENEVA, 19 September 2023—UNAIDS has named the First Lady of Sierra Leone, Fatima Maada Bio, as a UNAIDS champion for the empowerment and engagement of adolescent girls and young women in Sierra Leone. UNAIDS Executive Director, Winnie Byanyima, confirmed the appointment during a meeting with Mrs Maada Bio and her husband President Julius Maada Bio at the 78th session of the United Nations General Assembly taking place in New York.

“I am delighted to welcome Her Excellency Mrs Fatima Maada Bio to the UNAIDS family as a champion for adolescent girls and young women,” said Ms Byanyima. “The First Lady is a strong advocate for the empowerment of women and girls. I look forward to continuing to work together to end gender inequalities that drive HIV including sexual and gender-based violence, and to ensuring that our girls and young women have all the information and knowledge they need to lead healthy lives.”

Mrs Maada Bio is a leading advocate for the Hands Off Our Girls Campaign, a movement launched by President Maada Bio in December 2018 to ban early child marriage and end sexual violence against women and girls. In 2022, she spearheaded the adoption of the first ever World Day for the Prevention of, and Healing from Child Sexual Exploitation, Abuse and Violence, which is commemorated annually on 18 November.

Mrs Maada Bio is also a champion of Education Plus, an initiative launched by UNAIDS, UNESCO, UNICEF, UNFPA and UN Women to prevent HIV infections through free universal, quality secondary education for all girls and boys in Africa, reinforced through comprehensive empowerment programmes.

“My hope is for a future where all women have equal rights,” said Mrs Maada Bio. “Where women and men can sit at the same table and make decisions together, where women are given the space to lead. That is my hope because then we will know that real equality has arrived for us all.” 

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.