Mozambique

MAPUTO, MOZAMBIQUE, 16 June 2023 – Ambassador Dr. John N. Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, visited Maputo June 14-16. Ambassador Nkengasong was accompanied by UNAIDS Executive Director Winnie Byanyima, who leads the United Nations’ efforts to end the AIDS pandemic by 2030, and Head of Grant Management at the Global Fund Mark Edington. This historic joint visit, the first time that these three organization leaders visited Mozambique together, underscores the strong commitment to combat HIV/AIDS over the past 20 years as well as the critical importance of a sustainable HIV/AIDS response.

During their visit, the delegation met with Prime Minister Maleiane, Economy and Finance Minister Tonela, and Health Minister Tiago, as well as civil society organizations. In those meetings, the delegation emphasized the need to develop a sustainable HIV/AIDS response, the importance of protecting human rights, and the need to work across several ministries when addressing the HIV/AIDS epidemic in Mozambique. The group also visited Primeiro de Maio, a high-volume health facility in Maputo supported by PEPFAR and the Global Fund that aims to prevent new HIV and TB infections and increase access to quality care and treatment services for people living with HIV.

“Saving lives and ending HIV/AIDS as a public health threat in Mozambique – and globally – by 2030 requires a sustainable HIV/AIDS response,” stated Ambassador Nkengasong. “The United States, Global Fund and UNAIDS are united in our partnership with Mozambique to see this through. Through country leadership, collaboration with bilateral and multilateral partners, and strong engagement from civil society, Mozambique can achieve the UNAIDS HIV treatment targets by 2030.”

“This joint visit to Mozambique has inspired us all,” noted Winnie Byanyima, UNAIDS Executive Director. “The end of AIDS is possible, but only by working together as government, civil society, international partners and UN, by empowering women and girls, and by ensuring no one is stigmatized nor excluded. In a country where the face of HIV is that of a girl, where every 20 minutes an adolescent girl or young woman is infected, we have seen how by scaling up the lessons of effective programs we can overcome the inequalities holding back the end of AIDS. To reach everyone, it will take all of us.”

“Mozambique has made solid gains in reducing the spread of HIV and it has been impressive to see some of the work behind the progress on this trip,” said Mark Edington, Head of Grant Management at the Global Fund. “We are deeply committed to helping Mozambique end HIV/AIDS as a public health crisis, but sustaining and scaling this progress so far will take strong engagement from all partners, the government and civil society.”

The U.S. government, the Global Fund, and UNAIDS have provided significant, ongoing support for Mozambique in its fight against HIV/AIDS since they were founded. Each year, the United States invests more than $400 million in PEPFAR funding to Mozambique aimed at ending HIV/AIDS as a public health threat by 2030. Over the next three years, the Global Fund plans to invest $770 million for HIV, TB, and Malaria. The U.S. government has supported Mozambique in its fight against HIV/AIDS since the Mozambique PEPFAR Coordination Office opened in 2003.

Progress against HIV has been uneven. The gains made through people-centred approaches within the highest performing HIV programmes have been tempered by insufficient action in other countries.

Zimbabwe has been an HIV testing and treatment leader. The southern African country’s AIDS Levy has mobilized a significant amount of domestic funding, communities are strongly engaged in service delivery and international financial and technical support has been strong and consistent. Eighty-two per cent of adults living with HIV in the country have suppressed viral loads. Neighbouring Mozambique, by contrast, has lagged behind the regional average, leaving nearly half (44%) of adults living with HIV in the country with unsuppressed viral loads. Conflict, climate change, high levels of poverty and poor health infrastructure are among the country’s many challenges.

The AIDS movement in Mozambique has lost one of its founding and leading activists, Tauzene Murgo, who died on 12 July 2020 in Maputo at the age of 42 years. Throughout his adult life, Mr Murgo advocated for accelerated access to HIV treatment and support for people living with HIV in Mozambique.

Mr Murgo was a founding member and Executive Director of Pyuka hu Hanya, which means “Wake and live” in Changana, a local language in the southern region of Mozambique. Pyuka hu Hanya was established in 2005 with the objective of improving the quality of life of people living with HIV. The organization provides a support network and platform for people living with HIV to build community engagement to improve the quality of health services and to design community-led projects. Pyuka hu Hanya was among the first organizations in Mozambique to offer support to people living with and affected by HIV, specifically mobilizing and linking people to health services.

Mr Murgo was tireless in his efforts to amplify the voices of people living with HIV, championing the greater involvement of people living with HIV in decision-making, monitoring and reporting to ensure that policies and services are responsive to community needs. At a time when HIV treatment was just starting to be available, he was a driving force in addressing issues around stigma and discrimination.

Mr Murgo was close friend of UNAIDS for a long time and an active member of the civil society platform on health and human rights. He collaborated with UNAIDS in raising awareness about the needs of people living with HIV, constantly reminding decision-makers and partners that “health is a right”.

“Mr Murgo was a passionate activist and leader who dedicated his life to ensuring that people living with HIV in Mozambique have access to life-saving HIV treatment,” said Eva Kiwango, UNAIDS Country Director for Mozambique. “He tirelessly advocated for increased funding for organizations of people living with HIV, to scale up community responses to HIV. We share in the sadness and offer condolences to his family and all who knew and loved him. He will be sadly missed.”

Photos: UNAIDS/P.Caton

It’s been a year since Cyclone Idai made landfall in Sofala Province, Mozambique, where one in six of the population is living with HIV. The cyclone caused devastating floods that destroyed homes and washed away savings, documentation and medicines. Thousands of people were displaced. Health centres across the province were destroyed or severely damaged.

Working with national and provincial authorities, including Mozambique’s Ministry of Health, UNAIDS responded by helping to re-establish community-based support programmes to find thousands of people who had been lost from HIV treatment in order to ensure that they received the necessary support to get back and remain on treatment.

Community volunteers and HIV activists received bicycles from UNAIDS to help them reach people affected by the flooding and to locate people lost from treatment programmes.

Community activists fanned out across areas affected by the disaster.

When the cyclone hit, 14-year-old Pedro José Henriques lost everything, including his medication and his identity card. Community activists supported by UNAIDS helped him receive a new identity card so that he could re-register at the health clinic and obtain new antiretroviral medicines.

“I was so happy to get my new medicines,” he said. “When the activists found us, we had nothing. At least now my grandmother and I have somewhere to stay. It’s not much, but it’s better than sleeping in the cold.”

Rita Manuel is disabled and living with HIV. Her husband is also HIV-positive. When they lost both their children to AIDS-related illnesses, they decided to stop taking their HIV medicines. They simply lost the will to live.  

After the cyclone, activists in the lost-to-follow-up programme visited the couple three times. Finally, Ms Manuel and her husband agreed to visit the health centre and resume their medication.

The activists belong to an association called Kupulumussana, which means “we support each other”.

Ms Manuel is now involved in some of the association’s activities herself. “I am not really happy because I wish I had known about this treatment for my children,” she said, “But I am grateful to be alive and to have people supporting me. The situation is better than before.”

Peter Joque is also in an association to help people affected by the disaster. The Kuphedzana association helped Mr Joque rebuild his home after the cyclone and helped him get back on his feet.

This motivated him to start helping to find people in need of HIV medication. He uses hospital records to search for those who were displaced.

When he finds someone, he takes time to talk to them about the importance of staying on treatment. Mr Joque’s door-to-door strategy managed to locate 40 people living with HIV and persuade them back on to antiretroviral therapy. 

“Talking to someone face to face means it is easier to persuade the person to return to the health centre,” he said. “Stigma and discrimination is still a challenge among communities.”

Medical staff like Alfredo Cunha at the Macurungo health facility treat all patients with respect and dignity. Everyone receives the best care possible.

Sowena Lomba lost her husband to an AIDS-related illness in 2014. When she started getting ill, she thought she had malaria, but when she tested for HIV the result came back positive. During the flooding she lost her identity card and was no longer able to receive treatment. Activists helped her to receive new documents and get back on to treatment.

Ms Lomba says she is grateful to be alive for the sake of her children, Evalina and Mario.

Community activists have now helped more than 20 000 people back on to treatment over the past 12 months and say they won’t stop until they have found everybody lost to treatment, including those who were in need before the catastrophic events of March 2019.

“We are still at it and we will not stop until everybody living with HIV is receiving treatment and care,” said one of the activists.

The President of Mozambique, Filipe Jacinto Nyusi, chaired an extraordinary board meeting of the National AIDS Council on World AIDS Day in Maputo, Mozambique. The meeting brought together government representatives and community and religious leaders from all provinces of the country and national and international stakeholders to reinforce the country’s commitment towards ending AIDS as a public health threat by 2030.

In his opening speech, Mr Nyusi underlined that everyone, including community members, government representatives and religious leaders, has a role to play in the response to HIV and called on everyone to join forces to overcome the cultural barriers that are preventing people living with HIV and key populations accessing the services they need. He also stressed the importance of protecting adolescent girls and young women and emphasized that an innovative communication strategy will be required to bring about social change.

UNAIDS Deputy Executive Director Luiz Loures commended the country’s leadership for the progress made in the past 10 years, with almost 1 million people accessing antiretroviral therapy. He also stressed the importance of providing space and resources to communities, as they are key to advancing the response to HIV and to reaching populations that otherwise would be left behind. He also assured Mr Nyusi that UNAIDS will strongly support Mozambique’s efforts to end the AIDS epidemic.

Carlos Agostinho do Rosário, Prime Minister of Mozambique and Chair of the National AIDS Council board, chaired the open plenary discussion with community leaders. Nazira Abdula, Minister of Health of Mozambique, other cabinet ministers, Iolanda Cintura, Governor of Maputo City, and David Simango, Mayor of Maputo City, were among other high-level officials of the country present at the meeting.

The participants at the meeting agreed that scaling up HIV prevention programmes, putting communities at the centre of the response, addressing stigma and discrimination and focusing on achieving the 90–90–90 targets are urgently needed to step up the pace of the response to AIDS in the country.

This story was originally published by UNICEF

In Mozambique there has been some progress in the fight against AIDS, notably in preventing mother to child transmission of HIV. But progress in preventing new HIV infections among adolescents (10-19) and improving testing and treatment in adolescent populations are still unacceptably slow.

Around 120,000 adolescents live with HIV (UNAIDS 2017). The data also reveals a worrying gender disparity: according to IMASIDA 2015, HIV prevalence among adolescent girls 15-19 is four times higher than for boys (6.5% vs 1.5%). Prevalence is also higher in urban areas than in rural.  Young women have higher odds of HIV infection due to various factors including gender norms, reduced access to information, and age-disparate sex. Additionally, not knowing one’s HIV status and engaging in high risk practices predisposes young people to the risk of contracting HIV. This highlights the need for adolescents and young people to have access to appropriate information as they explore their sexuality.

The AIDS epidemic must remain a global public health concern, according to UNICEF and UNAIDS. Innovative solutions must be adopted to speed up progress in preventing HIV infection of children and adolescents and ensuring those living with HIV get the treatment they need. 

In 2015, in the context of the youth-focused Sexual and Reproductive Health (SRH) and HIV prevention Geração Biz (Busy Generation) programme, UNICEF Mozambique partnered with line ministries of Youth and Sports; Health; Education and Human Development; UNFPA and the youth association Coalizão (Youth Coalition) to adapt the SMS-based technology for development platform U-Report and roll out the programme known as SMS BIZ. This was aimed at improving adolescent and young people’s access to comprehensive and personalised SRH and HIV information through SMS (for more information visit http://mozambique.ureport.in/).

SMS BIZ partners set up a counselling hub managed by Coalizão with 24 trained peer counsellors, equipped with ICT facilities and a reference guide on SRH, HIV and Gender-based Violence (GBV) prevention to facilitate their capability to respond to adolescents queries. The counseling service is totally anonymous so neither the counsellors nor users can identify the other. Counsellors respond to about 1,000 questions daily. A total of 350,000 questions were responded to date. Communication and promotion materials were developed to promote the counselling service while advocacy sessions were held in selected provinces in order to create synergies with different stakeholders. Partnerships with the three Telecom Operators allowed SMS BIZ partners to count on free un-limited SMS for the period of 2017-2020.

In only two years, SMS BIZ/U-Report, has exceeded expectations with over 110,000 active adolescents and youth registered by September 2017, using the services for information on topics relevant to them.

Adolescents and young people registered have been engaged in discussions addressing misconceptions about SRH, HIV prevention and treatment, and increasing uptake and linkages to HIV and GBV services. Results from a poll show positive results, with 65% of adolescents and young people that responded to the poll were referred and adhered to health facilities during the counselling session for additional individual face-to-face counselling, consultation or treatment.

However, until recently, the challenge has been attracting as many girls as boys to the platform with a ratio of 60% boys - 40% girls. Raima Francisco Manjate, one of the SMS BIZ/U-Report stellar peer counsellors officially launched the Girl-to-Girl invite system on the International Day of the Girl Child on October 11th, with an intervention at the National Girls Conference organized in the context of the UN Joint programme Action for Girls, funded by the Swedish Government. The results have been outstanding: in 72 hours, more than 8,600 girls were successfully registered, the girls' user population grew from 4% to 44%, with five girls registering more than 50 friends and winning the competition.

Today, the total number of SMS BIZ/U-Report users reached 130,000.

The five adolescent and young girls, winners of the competition, have been awarded today at the World AIDS Day Celebrations, in Maputo and in the provincial capitals of Quelimane, Nampula and Beira in recognition of their efforts in mobilising friends to adhere to this important counselling service.

Neima Muianga, 20 years old and Cristina Djive, 18 years old,  both from the capital Maputo, were the two girls awarded today at the WAD ceremony, by the following high-level dignitaries such as Mr. Carlos Agostinho do Rosario, Mozambique Prime Minister, Mr. Luiz Loures, UNAIDS Deputy Executive Director, Ms. Nazira Abdul, Health Minister and Ms. Clarisse Machanguana, UNICEF National Ambassador.

Neima was thrilled when she discovered she had won the competition: “I feel happy about it. I have sent various SMS to contact numbers on my list, my neighbours, church members and even girls or young women I would bump into in the streets. SMS BIZ is very important for us. I don’t feel comfortable speaking with my parents about sexuality as this is taboo in Mozambique”.

"It is an excellent example of how young people can empower each other through technologies and innovative projects. Girl-to-Girl (G2G) is the kind of innovation that has an essential role for gender equality and health as we work to leave no one behind in implementing the sustainable development goals," said Luiz Loures, UNAIDS Deputy Executive Director, Assistant Secretary-General of the United Nations.

Now that the SMS BIZ/U-Report initiative has been scaled up at national level, SMS BIZ partners expect to reach and engage approximately 400,000 adolescents and young people by 2020. According to Cristina “this initiative cannot stop. So far, it has been a great experience for us.”

During a visit to Mozambique on 6 and 7 March, UNAIDS Deputy Executive Director Luiz Loures applauded the country’s efforts to Fast-Track its AIDS response. His visit took place at a critical moment for Mozambique, which is determined to accelerate its response to HIV with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief, whose representatives Mr Loures met.

Mozambique is among the countries most affected by the AIDS epidemic. HIV prevalence among adults was estimated to be 10.6% in 2015, with approximately 1.5 million people living with HIV. Nonetheless, and despite the challenges the country faces, Mozambique stands out as an example of how progress can be achieved through political commitment and international support. The coverage of antiretroviral therapy and HIV testing and counselling has increased considerably during the past years. By mid-2016, approximately 892 000 people living with HIV were receiving antiretroviral treatment, compared with around 308 000 people in 2012. New HIV infections among adults have been reduced, by 40% from 2004 to 2014.

In a meeting with the Minister of Health, Nazira Karimo Vali Abdula, Mr Loures congratulated the government for its significant progress. He recognized that while challenges remain, the country’s experience constitutes a showcase for the world of how to respond to the AIDS epidemic. The minister underlined the relevance of UNAIDS as a key coordinating platform for the international community and praised its global strategic leadership.

An important meeting during the trip was with the Mozambican Civil Society Platform for Health (PLASOC-M), which warmly welcomed him to the civil society meeting, held weekly at the UNAIDS country office. PLASOC-M unites local organizations helping to ensure close linkages between the national health system and the grass roots. After a productive exchange, Mr Loures pledged to back their efforts and to advocate on their behalf. He underlined the particular importance civil society has for populations that are hard to reach and often left behind, such as adolescent girls, sex workers, lesbian, gay, bisexual, transgender and intersex people, migrants, injecting drug users and prisoners.

The former President of Mozambique and Vice-Chairman of the Champions for an AIDS-Free Generation in Africa, Joaquim Alberto Chissano, received Mr Loures at his foundation’s headquarters. In the discussion between them, the need to revitalize primary HIV prevention, especially among youth, and the need to strengthen coordination and collaboration among lusophone countries in the HIV response, were highlighted.

Mr Chissano also highlighted the important role of private companies in the revitalization of HIV prevention, especially among youth, and pledged his continued support to this important issue.

HIV prevalence among adults is particularly high in Mozambique. In 2014, an estimated 1.5 million people were living with HIV in the country and HIV prevalence was estimated at 10.6%, the eighth highest in the world. However, the country is firmly committed to adopting the UNAIDS Fast-Track Strategy to break and end its AIDS epidemic by 2030.

With international support, Mozambique has managed to sharply increase its coverage of antiretroviral therapy and HIV testing and counselling since 2012. Expanded treatment coverage for pregnant women living with HIV has resulted in a 73% decline from 2011 to 2014 in new HIV infections among children. New HIV infections among adults have also been reduced, by 40% from 2004 to 2014.

During a joint mission to Mozambique on 7 and 8 December, the Executive Director of UNAIDS, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the Coordinator of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) congratulated the country for accelerating its HIV response.

In their first country mission together, Michel Sidibé of UNAIDS, Mark Dybul of the Global Fund and Deborah Birx of PEPFAR held constructive meetings with high-level governmental officials, United Nations representatives, the United States Ambassador and members of civil society. Their mission was aimed at enhancing the support provided to the country for implementing its national priorities and at strengthening the joint partnership.

They all spoke of their continued and common commitment to Mozambique and to ending the AIDS epidemic by 2030. They also highlighted the importance of ensuring that people who test positive for HIV have immediate access to HIV services, including treatment.

In a meeting with President Filipe Jacinto Nyusi, Mr Sidibé praised the government for championing a people-centred approach to health and development for everyone. He also commended the government for adopting a law in 2014 that seeks to protect the rights and dignity of people living with HIV.

Mr Sidibé welcomed the recent creation of a budget line for HIV treatment in the domestic health budget. In a meeting with the Minister of Health, Nazira Karimo Vali Abdula, he stressed that a greater domestic financial commitment is still required for a sustainable response to its epidemic. The country is currently dependent on international donor support.

Mr Sidibé attended the launch of the Fast-Track cities initiative in Maputo, which aims to achieve the UNAIDS 90–90–90 treatment target in the capital. At the signing ceremony, the Mayor and Governor of Maputo City pledged to Fast-Track the AIDS response for marginalized groups and ensure that no one is left behind.

Mr Sidibé also met with Joaquim Alberto Chissano, former President of Mozambique and a Champion for an AIDS-Free Generation in Africa, and Graça Machel, Founder of the Graça Machel Trust and Chair of the Partnership for Maternal, Newborn & Child Health.