Asia Pacific

In 2020, a gay Thai man living with HIV sparked controversy with a Facebook post. He was on antiretroviral therapy and had gotten lab tests to check the level of virus in his blood. Since his viral load was undetectable, he wrote, he was going to stop using condoms.

The public responded with a mix of contempt and disbelief. How could he? So selfish! So reckless! The resulting debate spilled from social media onto national radio and TV.

“There was a huge backlash,” remembered Dr Nittaya Phanuphak, the Executive Director of the Institute of HIV Research and Innovation (IHRI). She was telling the story from IHRI’s sunlit offices to teams from Botswana, Ghana, Ivory Coast, Jamaica, Mozambique, South Africa and Zambia. They’d come to Bangkok as part of a learning exchange coordinated by the Global Partnership for Action to Eliminate all Forms of HIV-related Stigma and Discrimination.

Dr Nittaya said that she and her father, Professor Praphan Phanuphak, thought it was their duty to contribute to the public discourse. While the man’s approach might have been unconventional, the science behind his statement was sound.

They would know. Professor Praphan diagnosed Thailand’s first HIV case in 1985 and dedicated his life to HIV research, service delivery and advocacy. He co-founded the Thai Red Cross AIDS Research Centre which in 2014 conducted cutting-edge research as part of the Opposites Attract Study. Done in Australia, Brazil and Thailand, that study tracked couples in which one person was HIV-negative and the other was living with HIV but had achieved an undetectable viral load through successful HIV treatment.  It confirmed that after two years of unprotected sex, there were no cases of HIV transmission between more than 300 couples. 

“It’s a scientific fact,” Dr Nittaya said. “For me, I felt like we really needed to do something. We cannot just wait 50 years for this knowledge to gradually seep into Thai society.”

The “knowledge” to which she refers is the concept of undetectable = untransmittable, or U=U for short. Last year the World Health Organization further endorsed the principle, stressing that when a person’s viral load is undetectable there is zero chance of sexual transmission.

“Before, HIV treatment just meant longevity,” said Pan (not his real name), a person living with HIV. “But with U=U, now it is love without fear.”

Within three to six months a person who takes their HIV treatment as prescribed and receives viral load monitoring can confirm that they have achieved an undetectable viral load. This removes the self-stigma associated with having an “infectious” disease. For Thai HIV response stakeholders, this concept can also transform the public’s attitudes about people living with HIV, making it easier for them to live full, happy lives.

“If social perceptions can be brought in line with the reality of HIV treatment, we can remove the stigma around getting an HIV test or diagnosis,” said Eamonn Murphy, Regional Director of UNAIDS Asia Pacific and Eastern Europe Central Asia. “The more supportive the society, the more people we successfully treat and the fewer new infections.”

But for the U=U strategy to be fully utilized, work must be done to dispel myths and bolster confidence in science.

According to UNAIDS Country Director for Thailand, Dr Patchara Benjarattanaporn, a key step in the national process was bringing decision-makers together with relevant stakeholders, including voices from communities.

“They considered both global and local evidence,” she explained. “Now there is consensus about the science. U=U also conveys the message ‘you=you’, affirming that all individuals are equal and that people are more than their HIV status. It emphasizes the importance of ensuring people are fully informed about their options and respecting their right to make choices about their sexual health depending on their realities.”

At the opening ceremony of the eight-country learning exchange, Dr Niti Haetanurak, Department of Disease Control Deputy Director, noted that the U=U concept is a key element of Thailand’s “all of society” strategy to address the prejudice and rights violations people living with HIV face. Thailand has a National Costed Action Plan to Eliminate all forms of HIV-related Stigma and Discrimination. The Ministry of Public Health and Sub-National Committee on AIDS Rights Promotion and Protection under National AIDS Committee coordinate the effort. Community organizations play a leading role.

During the exchange the country teams visited the Service Workers in Group (SWING) Foundation which serves sex workers and IHRI’s Tangerine Clinic which primarily serves transgender people. Both have come up with innovative approaches to ensure groups that usually find it challenging to receive healthcare at state-run facilities can get HIV and sexually transmitted infection (STI) testing and treatment in a friendly environment.

A key strategy is training members of those very communities to provide certain services themselves. They can even start clients on treatment for HIV and some other conditions the same day they are diagnosed. This approach makes it less likely for people to disappear into the shadows after diagnosis, with a high chance of infecting others and eventually becoming ill.

“This community-led health model can be applied to any health condition or population. But this does not really address stigma and discrimination. It just bypasses it by opening up alternative service delivery outlets for people who want to avoid negative experiences elsewhere,” Dr. Nittaya said.  “We need to address the heart of the stigma as well. That is why we are working on using U=U as a tool to explore how we can shift attitudes.”

The Bangkok Metropolitan Administration (BMA) is integrating this concept into its work in healthcare settings and the workplace. A masterplan is in the works. One branch of the strategy will tackle employers requiring HIV testing in the pre-employment phase or targeting employees they find out are living with HIV. Another aspect of the approach is the integration U=U into all levels of HIV service delivery and ongoing healthcare worker sensitization. All staff in clinics and hospitals are trained, not just nurses and doctors.

The work doesn’t stop there, though. Describing the Bangkok society as “open”, Dr Tavida Kamolvej, Deputy Governor of Bangkok, said that the whole of society was ready for deeper conversations about inclusion and HIV. But how could these approaches be applied in other countries and cities that are not quite as tolerant or accepting, she was asked.

“If you are confronted with beliefs that might not allow open conversations about HIV, sexuality and sex, you can strategically make it about health literacy, dignity and care for all people. I think this is soft enough to make people aware about health and wellbeing,” Dr Tavida advised.

Click here to learn more about the recent eight-country learning exchange to eliminate all forms of HIV-related stigma and discrimination.  

There are around 1.4 million people living with HIV in China and women make up around 23.7% of them, according to the latest data from Chinese health authorities. Among those living with HIV are pregnant women who are in a particularly vulnerable position due to the stigma surrounding the disease.

In order to counter such stigma and discrimination, women living with HIV and Hepatitis B came together at The Voice of Resilience event to tell their stories and to call for additional resources for community-based organizations (CBOs) working on the frontlines providing services for women living with and affected by HIV.

In 2023 alone, more than 5,000 pregnant women were diagnosed with HIV and over 400,000 with hepatitis B, and some of them were diagnosed at very late stage to be able to receive HIV services to prevent transmission to their children, according to China’s National Health Commission. Even though services are in place to prevent the transmission of HIV to their babies, discrimination, including denial of healthcare, obstructs women from accessing such services.

“I received a call from the doctor telling me that I couldn’t receive services from their hospital because I was HIV positive,” explained Xia Jing, one of the mothers, after she went to a general hospital in Beijing for a routine maternal exam. She still cannot hold her tears when she remembers her traumatic experience. She challenged back and told the doctor r that under the law they had no right to reject her.

She was eventually referred to Beijing’s You’an Hospital, a designated hospital for infectious diseases and people living with HIV where she delivered her baby. Now she is a happy mother of a four-year-old boy. Doctor Zhu Yunxia was the doctor who helped Jing deliver her baby. Dedicated to her job for more than 30 years, she is proud of having helped so many women deliver healthy babies. She calls for empathy with people facing discrimination and unfair treatment and urges all people to look at women living with HIV without prejudice.

“Stigma undermines public health objectives by creating barriers to accessing health and social services and can reduce the quality of the services that members of affected communities receive,” said Mark Vcislo, the First Secretary at Canadian Embassy to China, which has supported the work to tackle stigma. He called for breaking down “the prejudices that can prevent and deter marginalized communities, including persons living with HIV, from accessing the health and social services they need and deserve.”

Community-based organizations (CBO) are vital support for women living with HIV. Sister Xin, for instance, who herself received help from community volunteers when she was first diagnosed with HIV, created Firefly, a community-based organization that has help more than 20,000 women living with HIV in the last 20 years. Zhang Yu whose CBO supports women living with HIV in rural areas of China’s southwestern Yunnan Province, called for more resources for CBO’s work. “CBOs are struggling with their survival due to lack of resources,” she said. “I sincerely hope the government, the charity organizations and everybody can support us to continue our work.”

China has developed a strong and ambitious plan to significantly reduce the transmission rates of HIV, syphilis, and hepatitis B by 2025 outlined in China Women’s Development Plan and Healthy China 2030. China has achieved around 99 percent national screening rates among pregnant women living with HIV over the past five years. In 2023 alone, more than 9 million pregnant women have received HIV testing services. 

The Chinese government has partnered with UN agencies for the “last mile” by building a patient-centred and family-centred community service model to enable a holistic set of services and help break the barriers for both mothers and infants.

“Thanks to the combination of development of technology and social progress, women living with HIV can today give birth to healthy babies,” said Sister Xin.

Read the profile of the storytellers and more unsung community heroes committed to  helping mothers and babies: http://www.unaids.org.cn/page122?_l=en&article_id=1233.

Every pain yields a lesson, and every lesson transforms a person

Parisa's life was forever altered by HIV 25 years ago. The virus struck her family, snatching her husband's job and halting her child's education. Tragically, her husband passed away two years later, leaving Parisa to navigate the daunting landscape of loss and discrimination.

Undeterred by adversity, Parisa embarked on a relentless mission for human rights, determined to combat the pervasive stigma and discrimination surrounding HIV. Initially, she immersed herself in seminars and conferences, volunteering tirelessly at counselling centres, where she shared her own experiences to chip away at the stigma and discrimination.

Her unwavering dedication caught the attention of Dr Minoo Mohraz, the former director of the Iranian Research Centre for HIV/AIDS (IRCHA), who offered her a pivotal role in a Positive Club—a sanctuary for those grappling with similar challenges. Thus began Parisa's transformative journey, marked by a series of initiatives aimed at raising awareness, eradicating stigma and discrimination, and supporting her peers.
 

WHAT IS THE POSITIVE CLUB INITIATIVE? The Positive Club is a meeting place for people living with HIV, who run the club themselves, with supervision from Parisa and colleagues. At the club, people receive training in arts, and sports, and as peer educators.  The Positive Club initiative was one of the successful programmes aimed at promoting positive health, dignity, and HIV prevention; it has been running for over 12 years with support from UNAIDS in collaboration with national partners and civil society organizations. Through this initiative, over 10,000 people living with HIV have been supported across 25 Positive Clubs, empowering them through training classes, workshops on HIV prevention, care and treatment, counselling sessions, and psychosocial support.

Over the years, Parisa's efforts have been nothing short of extraordinary. From managing a Positive Club in Tehran to representing people living with HIV in various influential platforms, including Iran's Country Coordinating Mechanism, its Oversight Committee, and Global Fund, she has been a relentless advocate for change. 

Her initiatives have spanned diverse arenas, from radio shows and collaborations with filmmakers to training workshops for religious leaders and healthcare providers. Parisa's impact reverberates across borders, as she leverages regional platforms like MENA Rosa --the first regional network dedicated to women living with HIV in the Middle East and North Africa-- to exchange experiences and champion global efforts against HIV stigma and discrimination with a particular focus on Women living with and affected by HIV.

Amid the COVID-19 pandemic, Parisa's compassion for people living with and affected by HIV was once again evident. She mobilized support networks to provide essential supplies for Positive Club members and vulnerable families, ensuring that the crisis does not exacerbate the challenges faced by PLHIV.

Reflecting on the progress made over the last 25 years, Parisa acknowledged the remarkable strides in combating HIV-related stigma and discrimination. Efforts to eliminate HIV-related stigma and discrimination have been led by the UNAIDS Country Office for Iran, alongside national partners of the AIDS Control Programme. Notably, the first PLHIV Stigma Index study, conducted in 2010, laid the foundation for understanding the landscape of stigma in Iran. Subsequently, a second PLHIV Stigma Index study, was carried out by the network of PLHIV in collaboration with UNAIDS, Global Network of PLHIV (GNP+), International Community of Women Living with HIV (ICW), Johns Hopkins Medical University (JHMU), National AIDS Programme (NAP), and with financial support from Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) /UNDP. Parisa played an important role in implementing the Stigma Index 2.0 which provided updated insights.
 

COMPARING OF BOTH OF IRAN’S STIGMA INDEX STUDIES A comparison between the two Stigma Index studies conducted ten years apart, using updated methodologies, revealed promising changes. The prevalence of self-stigma among PLHIV decreased significantly from 80% to 40%. Similarly, the percentage of PLHIV refraining from seeking medical help has decreased from 80% to 19%, underscoring improved accessibility to healthcare services and increased health-seeking behaviour among affected individuals. Overall, reports of stigma and discrimination have decreased from 71% to 47%, reflecting tangible improvements in societal attitudes to HIV.

Parisa reflects on these notable shifts in HIV-related Stigma observed between the two studies. In the initial Stigma Index conducted a decade ago, internal stigma was predominant among PLHIV, followed by societal and healthcare provider stigma. However, in the subsequent study, internal stigma was significantly reduced, while stigma and discrimination from healthcare providers emerged as the most prevalent issue. The improvement observed in internal stigma among PLHIV could be partly attributed to the work of the empowering Positive Clubs. Additionally, this improvement highlights the importance of ongoing efforts to address stigma and discrimination comprehensively, with a particular focus on healthcare settings. By acknowledging these shifts and persisting in their efforts, UNAIDS Iran, Parisa and her colleagues remain committed to building a future free from the burdens of HIV-related stigma and discrimination.

Through her nearly two decades of hotline counselling experience, Parisa has witnessed a shift in attitudes, with increased awareness and openness surrounding HIV discourse. 

She credits grassroots campaigns and community-led initiatives for driving this transformation, paving the way for a more inclusive society.

In 2019, Iran joined the Global Partnership to Eliminate all forms of HIV-related stigma and discrimination, prioritizing a strong emphasis on interventions within communities, emergency/humanitarian settings, and healthcare facilities. With support from UNAIDS, protocols and training packages were developed to address stigma and discrimination in these critical areas. These efforts were carried out in close collaboration with national partners and civil society organizations, with training workshops being a key component of the initiative.
 

OVERVIEW OF GLOBAL PARTNERSHIP The Global Partnership for action to eliminate all forms of HIV-related stigma and discrimination is a critical vehicle for action to mobilise all countries to reach the political declaration and Global AIDS Strategy targets. It leverages partnerships to enhance coordination of interventions and funding; it provides knowledge and evidence-guided technical support; and increases accountability mechanisms and community leadership.

Parisa was actively involved in the implementation phase of these projects. Her contributions have been instrumental in advancing the work to eradicate HIV-related stigma and discrimination across humanitarian, healthcare, and community settings.

However, Parisa acknowledges the persistent challenges faced by PLHIV, from sporadic bouts of self-doubt to occasional rejections and the lingering shadows of depression and fear. Despite these hurdles, she remains steadfast in her belief that we can achieve a future free from stigma and discrimination.

As Parisa continues her tireless advocacy, her journey stands as a testament to the resilience of the human spirit and the power of collective action in fostering a world where every individual, regardless of their HIV status, is embraced with dignity and compassion. 

UNAIDS has played a pivotal role in the establishment and sustained operation of Positive Clubs for over a decade, catalyzing transformative changes in the lives of people living with HIV such as Parisa and in the fight against stigma and discrimination. Nonetheless, the journey towards eliminating stigma and discrimination remains unfinished, albeit considerably smoother and more steadfast with the collaborative efforts and political commitment of initiatives such as the Global Partnership.

BEIJING, 15 July 2024 – The Joint United Nations Programme on HIV/AIDS (UNAIDS) and China signed two new Memoranda of Understanding (MOU) to advance joint strategic efforts to end AIDS in China and globally.

The first agreement was signed on 10 July by Wang Hesheng, Vice Minister of the National Health Commission and Administrator of the National Disease Control and Prevention Administration (NDCPA) and Winnie Byanyima, Executive Director of UNAIDS, in Beijing. UNAIDS and China have agreed to deepen their collaboration to reach the 2030 Sustainable Development Goals, within the context of China’s Global Development Initiative (GDI) and the Belt and Road Initiative (BRI). The agreement acknowledges China’s commitment to take a leadership role in the global HIV response including mobilizing partners and supporting efforts to end AIDS in middle- and lower-income countries. 

Mr Wang thanked UNAIDS’ for technical support and guidance around China’s HIV response, particularly in formulating HIV response plans and strategies, monitoring and assessment, as well as UNAIDS’ data collection and analysis.

“We expect to continue and further our cooperation with UNAIDS with this MOU,” he said. “The first steps will be to boost communication and coordination, and actively participate in global health governance.”

According to the agreement, NDCPA will make an annual contribution of USD$1 million to UNAIDS from 2025 to 2029, totaling USD$5 million, which includes increased core funding.

The other agreement signed in Beijing on 13 July with the China International Development Cooperation Agency (CIDCA) addresses critical global development issues to achieve the Sustainable Development Goals (SDGs), which includes promoting health and ending AIDS globally, especially in other developing countries in Africa and Asia Pacific.

Luo Zhaohui, Chairman of the CIDCA recognizes UNAIDS’ leadership in the global HIV response and encouraged UNAIDS to apply for more Global Development and South-South Cooperation Fund (GDF) to address the HIV epidemic.

“Let’s work together to improve people’s health especially after the COVID-19 pandemic.” he said. "HIV is a new area for CIDCA but UNAIDS has a lot of experience so there is huge prospect to have more cooperation.”

As part of this agreement, UNAIDS and CIDCA will fund projects in developing partner countries through policy coordination, community engagement, capacity building and technical insight.

Since its founding in 2019, the CIDCA has provided steady financial support to UN agencies and developing member states. As highlighted at the annual Steering Committee of UNSDCF, 13 UN agencies mobilized more than US$ 100 million in South-South funding, predominantly from CIDCA, which assisted 85 partner countries in the areas of COVID response and resilience, social inclusion, agriculture, climate and energy efforts. Earlier this year, UNAIDS received the first GDF to support Iran’s upscaling of rapid HIV testing. UNAIDS is the second UN entity to sign a MOU with the CIDCA.

UNAIDS looks forward to deepening cooperation with China especially in South-South Cooperation and China-Africa cooperation in the areas of local drug production as well as supporting partner countries.

Ms Byanyima said, “Global South solidarity is the bedrock of the HIV response. It is only by standing together that we can end AIDS by 2030 and I welcome steps towards a deeper partnership building China and African countries.”

UNAIDS will also closely work with the African Union, the African Center for Disease Control and Prevention and the African Medicine Agency.   

Ms Byanyima’s week-long mission to China is her first to the country since she became Executive Director of UNAIDS.

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, 30 May 2024— The Government of Australia and UNAIDS have today signed a new multi-million-dollar partnership to strengthen the fight against both non-communicable and communicable diseases, including HIV, to ensure better health outcomes for people in the Pacific and Southeast Asia. The signing took place at UNAIDS during the 77^th World Health Assembly.

The AU$12 million funding agreement will support governments and local communities in the region to improve HIV prevention, testing and treatment while reducing stigma and discrimination. The funds will be dedicated to advancing the HIV response in Papua New Guinea, Fiji, the Philippines, Indonesia, and Cambodia over the next four years.

“This is an important investment for the region, and a valuable partnership for UNAIDS. It will deliver multiple benefits, including tackling rising HIV infections in some countries,” said Christine Stegling, UNAIDS Deputy Executive Director. “This much-needed financial support by the Australian government will go a long way in the fight to end AIDS as a public health threat in the Pacific and Southeast Asia by 2030. More than that, it’s a demonstration of Australia’s commitment to protect people’s health and human rights beyond its own borders.”

Efforts to prevent new HIV infections in the Pacific and Southeast Asia need to be scaled up urgently as epidemics are rising in a number of countries including Papua New Guinea, Fiji and the Philippines. Stigma and discrimination are contributing to the rise, obstructing access to HIV prevention, testing and treatment services, particularly for men who have sex with men.

The financial injection, for both HIV prevention and treatment, adds to the existing AU$25 million multi-year (2022-2027) partnership between UNAIDS and the Australian Government in the Asia Pacific region, representing an expansion of the longstanding programming partnership. It’s also part of Australia’s Partnerships for a Healthy Region – an Australian Government initiative that works with governments and civil society organisations in the Pacific and Southeast Asia to build resilient, equitable and inclusive health systems that can respond to shared health challenges.

“Australia’s domestic response to HIV has always recognised that the people closest to the issue are also best placed to lead on the solutions. As policy makers and funders we must listen, support, and build genuine partnerships with affected communities and civil society organisations,” said Dr. Lucas de Toca, Australia’s Ambassador for Global Health. “Australia is proud these principles of listening and supporting are central to our new partnership with UNAIDS and Health Equity Matters. This new partnership will support locally led solutions to the HIV epidemic in our region – enabling affected communities to lead the response.”

Domestically, Australia remains committed to ending its AIDS pandemic by 2030 and recently announced a AU$43.9 million investment to boost the fight against HIV. Australia is well on the way to reaching the 95-95-95 targets by 2025.

“This commitment is a practical expression of solidarity and co-operation between the people of Australia and our near neighbours in Papua New Guinea, Fiji, the Philippines, Indonesia, and Cambodia,” said Dash Heath-Paynter, Chief Executive Officer of Health Equity Matters. “By investing in the HIV response in our region we plant the seeds for a healthier, more prosperous future, with a lighter burden of stigma and discrimination. We recognise the leadership exercised by both the Australian Government and UNAIDS in making this commitment."

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.

One-third of people living with HIV in Asia and the Pacific are women. But their issues are often hidden.

Gender-based violence. Restricted economic opportunities. Child marriage. Underage pregnancy. Denial of property rights.

A UNAIDS-supported initiative by the International Community of Women Living with HIV Asia and Pacific (ICWAP) supports positive women’s organising. The Feminist School is a learning and consciousness raising programme that began in South Africa, and has been utilised in Asia-Pacific since 2016. The methodology, anchored in feminist principles, is specifically designed to enable women living with HIV to understand their personal experiences, locate them politically and develop strategies for community-driven advocacy. 

“Marching in the month of March is not enough to realize women’s rights,” insists ICWAP Regional Director, Sita Shahi. “We need to speak up on the issue of gender inequality in the HIV response and the need for increased investments in women and girls. Women and girls living with HIV are going through serious human rights violations that, in turn, undermine their right to health.”

The Feminist School brings together women living with HIV, women from key populations, and young women from across the region.  In the past two years, with support from UNAIDS, ICWAP has made adaptations to include modules on sexual and reproductive health and rights, movement building, leadership skills and the elimination of mother-to-child transmission (EMTCT).

“Feminist leadership training reveals the challenges faced by women living with HIV in the region. I have gained a lot of knowledge from the cross-country discussions and learned lessons about how women from different countries are breaking down human rights-related barriers, including stigma and discrimination,” said Salina from Malaysia.

Last year, a new module on the Global Fund processes was added.

“We recognized the importance of ensuring that interventions led by women living with HIV are included in Global Fund funding requests,” explained UNAIDS Asia Pacific Regional Adviser for Community-Led Responses, Michela Polesana.

UNAIDS supported a Global Fund Grant Cycle Seven (GC7) project focused on supporting the engagement of networks of women living with HIV in Cambodia, India, Thailand and Viet Nam in the current process. It found that organizations in these countries were at different stages of readiness and involvement. For example, India’s Positive Women Network (PWN+) was already participating in the process and benefitted from ICWAP’s technical support to strengthen their advocacy and organization.

Another UNAIDS-supported strategy ICWAP employed to bolster GC7 engagement was the facilitation of peer-to-peer growth by and for women living with HIV through the roll-out of an online Feminist School training. Through this initiative, country networks were supported in engaging in the Global Fund process and learned about its gender equality strategy, including the gender equality markers (GEM). They also received training to support them in their work to hold governments accountable.

The organization partnered with Ikatan Perempuan Positif Indonesia (IPPI), the Thai Positive Women’s Network, Viet Nam’s Women’s Network, the Association of Positive Women Advocates Inc (APWAI) from the Philippines, Women affected by HIV and AIDS (WABHA) from Papua New Guinea and an informal network of women living with HIV in Cambodia.

The groups identified priority issues for advocacy and recommendations for next steps and devised country-specific advocacy plans.

The advocates agreed on a set of three shared priorities. First, a seat for women living with HIV on each Country Coordinating Mechanism. Second, for positive women networks to reclaim antenatal care activities in prevention of mother-to-child transmission programmes. And finally, for capacity building for young positive women leaders.

Feminist school is helping women living with HIV to organize to secure their human rights. To protect women’s health it is vital to protect women’s rights. And to protect women’s rights it is vital to support women’s leadership.

“This is all about bridging the gap between outgoing leaders and an incoming, new generation,” Ms. Shahi said.

Ibu Mawar (not her real name) learned she was living with HIV after receiving a test during an antenatal care visit.

 “I was surprised, of course, when they told me. But I didn’t really doubt or deny the result,” she remembered from the Sorong City Health Office in West Papua. She immediately started treatment to prevent transmission to her son. “Even though I’m positive,” she said, “our child is not.”

In principle, since 2009 every pregnant woman receiving antenatal care in Indonesia should receive an HIV test. And every woman found to be living with HIV should receive medicines to prevent transmission to their babies just as Ms Mawar did.

But this isn’t yet the reality.

In 2022 more than one-third (37%) of all pregnant women in Indonesia did not get screened for HIV and just 18% of mothers living with HIV had access to antiretroviral therapy. There were an estimated 2800 new HIV infections among children that year.

But now stakeholders in Indonesia are mobilising. Not only will they scale-up prevention of mother-to-child HIV transmission services, but they will work toward eliminating vertical HIV transmission while assuring the health and wellbeing of women and children living with HIV. At the centre of this approach is the engagement of women, who comprise roughly one-third of the adult population living with HIV.

In June 2023 Indonesia established the National Alliance to End AIDS in Children. This partnership between government, civil society and international organizations seeks to provide access to health services and support for women and children living with HIV. It has committed to three main priorities. The first is advocacy for the needs of adolescent girls and children living with HIV. Second is promotion and dissemination of information on Prevention of Mother-to-Child Transmission (PMTCT), Early Infant Diagnosis, treatment literacy and comprehensive sexual education. And third is the empowerment of communities regarding issues pertaining to children living with HIV.

The Alliance’s first major initiative was an Elimination of Mother-to-child Transmission symposium—the first ever in Indonesia. Partners have embraced the World Health Organization (WHO) triple target of eliminating mother-to-child transmission of HIV, syphilis and hepatitis B by 2030. A series of sessions were delivered in-person and online. A total of 115 participants from the government, communities, academia, healthcare and media joined the EMTCT Symposium in Jakarta.

Dr. Laila Mahmudah, Head of the Neo Maternal Division at the Ministry of Health, underlined the importance of accelerating EMTCT efforts across the range of issues. She noted that currently 66% of pregnant women received hepatitis B early detection services while just 25% of pregnant women are tested for syphilis.

Multisectoral stakeholders and participants discussed strategies with participants from Malaysia and Thailand, which have both received EMTCT validation for HIV. Dr Anita Suleiman, Director of Disease Control of the Ministry of Health of Malaysia, pointed to the importance of effective leadership and health system governance for country-wide implementation.

“One of the lessons from countries that achieved EMTCT is that it is possible to end AIDS and vertical transmissions, especially in low-prevalence regions like Indonesia, through robust governance and good-quality performance. Indonesia can also achieve EMTCT by 2030, and I hope this symposium leverages the coordination efforts towards the elimination of HIV, syphilis and hepatitis B,” said Dr Shafflq Essajee, Senior Advisor, HIV, UNICEF New York.

However, it was emphasised that political commitment must be bolstered by community-led strategies to reach and retain mothers living with HIV. Community mobilization and community health workers are critical approaches. Ikatan Perempuan Positif Indonesia (IPPI), the national network of women living with HIV, also endorsed the Thai approach of providing free formula for mothers living with HIV in low-resource districts.

Ayu Oktariani, IPPI National Coordinator and a member of the National Alliance to End AIDS in Children reiterated her organization’s commitment to implementing the community-led strategies in support of EMTCT in the coming years.

“This Symposium means more than words I can explain,” said Ayu Raka from the Akar Cinta Kasih Foundation, a community organisation in Bali. “When I return to Bali, I will advocate for EMTCT with local multisectoral stakeholders and communities in my region. I am confident we can make a healthier society and improve health for all mothers and babies.”

UNAIDS Country Director for Indonesia, Krittayawan Boonto, promised the continuous backing of UNAIDS.

“We will continue to support not only mothers, but also fathers, in protecting babies from new HIV infections. I wish for Indonesia to become the fifth country in Asia Pacific to achieve EMTCT. But we can only do it with the leadership of communities,” she ended.

Divyanshi is an enthusiastic 18-year-old Indian girl with an inspiring personal story of courage and resilience. She was diagnosed with HIV at a very young age. She has never given up on her dreams.

“I became aware of my status around 2013-14 but it wasn’t until I moved to a care home that I understood the challenges of living with this virus,” said Divyanshi. “As a person living with HIV, I face stigma and discrimination when a friend or someone else gets to know about my positive status. But I take it as an opportunity to educate people about HIV and break their myths. I want to show the world that I can live a normal, healthy, and happy life as a person living with HIV.”

Divyanshi joined the Positive YUVA Network (PYN)—an innovative community-based organisation striving to uplift young people living with HIV—where she found support and guidance from her peers.

As a network of young people living with HIV, Positive YUVA Network is a community-based organization committed to support young people living with HIV and LGBTQI+ people in India. The organization focuses its efforts on supporting the mental health of the young people living with HIV through its “Buddy System”. This initiative acknowledges the psychological challenges experienced by young people living with HIV and supports them with professional counsellors who provide tailored assistance. 

The organization provides skills development opportunities, recognizing that empowering young people living with HIV with practical skills enhances their socio-economic prospects. Through mentorship programs, the Positive YUVA Network aims to instil confidence and self-reliance among the youth, helping young people to redefine their narrative.

At the Positive YUVA Network, Divyanshi discovered her passion for photography and with the help of her mentor, is now interning at a startup, capturing moments of joy and hope. Divyanshi is an inspiration to many in how she shows that no obstacle can deter her from chasing her aspirations.

The Positive YUVA Network also works to reduce stigma and discrimination associated with HIV by raising awareness in schools. For instance, the organization used the most recent World AIDS Day as an opportunity to initiate open discussions and correct myths about HIV and AIDS among school going children with a goal to create a supportive and inclusive environment that fosters understanding and empathy for all people. By fostering empathy and a respect for the rights of everyone, the initiative helps to advance the health of everyone.

Global HIV statistics reveal that 1 out of every 4 new HIV infections globally in 2022 were among young people (15–24 years). Recognizing this demographic vulnerability, a focus on youth-specific interventions is imperative for an effective HIV response.

This community-driven initiative, and many others like this one, is playing a critical role in removing barriers for young people to meaningfully engage in the HIV-response in India. It is a powerful example of how community-led organisations are transforming the AIDS response at grassroots level. 

“In India's HIV response, youth-led organizations infuse hope and resilience. These groups, driven by the energy and innovation of young minds, are building a more inclusive and informed society. Rights, recognition and respect are essential for public health efforts to succeed. The impact of organisations like the Positive YUVA Network is not limited to young people living with HIV and LGBTQ+ youth, it benefits everyone,” said David Bridger, UNAIDS Country Director in India. “We all need to recognize the indomitable spirit of these organizations—pillars of strength in our collective journey. Together, let us do all we can to support the vital role of youth-led initiatives as they lead us along the path that ends AIDS,” he added.

Imagine this: you’re a person living with HIV, and your household is facing financial hardship. You decide to run a small grocery business at home, keeping your status hidden. Despite accessing free HIV treatment, you cannot afford other essential health services. And when you need to buy medicine, you don't have enough for your children’s school supplies or nutritious meals.

Low incomes.

Unaffordable healthcare.

Employment insecurity due to HIV-related stigma and discrimination.

These realities create financial hurdles for the poor among people living with HIV and the key populations—gay men and other men who have sex with men, transgender women, sex workers and people who inject drugs.

In Cambodia, stakeholders are working to ensure that the social protection safety net specifically covers people living with, and at risk of contracting, HIV.

“People living with HIV do not only need medication, but also food. If we provide only the drugs they will not survive,” said  Tia Phalla, Deputy Director of Cambodia’s National AIDS Authority (NAA). He explained that nutrition support and other non-health related care are an integral part of the national policy for responding to HIV.

Cambodia is among the countries that are on-track to reach the 2025 Global AIDS Strategy testing and treatment targets. As of the end of 2022, an estimated 86% of people living with HIV in Cambodia were aware of their status. Impressively, more than 98% of diagnosed people were receiving treatment and 98% of those on treatment achieved a suppressed viral load last year.

The country hopes to further improve these results while enhancing the quality of life of people living with HIV.

“A key part of the strategy we have advocated for is to include HIV sensitivity in social protection schemes and programmes,” explained Patricia Ongpin, UNAIDS Country Director for Cambodia, Lao PDR and Malaysia. Individuals and families affected by HIV can now benefit from a range of programmes including cash transfer, food assistance, social health protection and scholarships.

Once a person living with HIV registers their household for an Equity Card, they are entitled to monthly stipends. The card also gives holders access to additional medical care. This frees individuals and families from having to choose between healthcare and expenses for other essentials such as education and food.

In 2019 Cambodia officially included people living with HIV in its IDPoor mechanism. This is a system to identify and register households living in poverty. This was followed by the HIV and Social Protection Assessment, conducted in 2020 by UNAIDS and the NAA.

“The assessment made it clear that promoting HIV-sensitive social protection could help reduce the risk of HIV, increase demand for HIV prevention services, and promote HIV testing and safe sexual behaviors, as well as adherence to treatment,” said Ms Ongpin.

To ensure a more inclusive approach for IDPoor registration there must be engagement from key stakeholders including government, local authorities, development partners, and civil society organizations.

With support from UNAIDS and UNDP, Cambodia’s Ministry of Planning launched a web-based system and mobile application for IDPoor registration in December 2022. This approach makes it easier for individuals living with HIV to register at their treatment centers. As of August this year, more than 13,600 people living with HIV have been enrolled.

By leveraging this technology-driven approach, people living with HIV feel confident revealing their HIV status and are empowered to access much-needed healthcare benefits with dignity and autonomy. The solution can also be used to register people from key population communities at risk of contracting HIV.

Community leadership is a key strategy for expanding the initiative’s reach.  The Joint Forum of Networks of People Living with HIV and key populations (DFoNPAM) coordinates with the Department of Planning at district level in order to help with IDPoor registration. 

One initiative specifically targeted female entertainment workers. A national registration campaign was co-organized by the Ministry of Planning, the Phnom Penh City Hall, and the NAA, with technical assistance from UNAIDS. Around five dozen workers registered during the two-day campaign, receiving Equity Cards for their households.

According to the UNAIDS Country Director, this inclusive approach is key to creating a better future for people living with HIV and key populations.

“To mobilize their participation and register them for Equity Cards, we need to understand the barriers. And to understand the barriers, we need to listen to their experiences, in their own words. By taking this step, people living with HIV and key populations can help shape the conversation and ensure that their voices are heard,” Ms Ongpin ended.