On the day of China’s Lantern Festival, 8 February, Shen Ming was making sweet dumplings, the traditional festival delicacy, at his home in Wuhan in China’s Hubei Province. From time to time, he would raise his head to watch the local news on the television to get the latest on the COVID-19 outbreak.

His paid particular attention to the new traffic restriction measures. Unlike most people in the city, who stayed indoors all day because of the lockdown, Shen Ming needed to go out almost every day—he is a volunteer who is driving people living with HIV to pick up their medicines from hospitals during the outbreak.

Shen Ming had planned to drive someone to Jinyintan Hospital in the afternoon. Just enough time to have the sweet dumplings, he thought. As the water began to boil, his phone rang. A colleague from the Wuhan Lesbian, Gay, Bisexual and Transgender Center asked him if he could drive another two people to get their medicine right away. He said yes. “You see,” he said. “It will save me a lot of time because I can drive three people to the hospital in one go.”

He switched off the hob and put on a protective suit and mask. “Never mind the sweet dumplings. I can cook them later,” he said. “Besides, I can have a video call with my parents while I’m having the dumplings in the evening.” 

A new year away from home

It was more than two weeks since Wuhan, the epicentre of the COVID-19 outbreak, was locked down. An uncomfortable silence hung over the city, which appeared deserted, in stark contrast to the energy of the city before the outbreak.

Shen Ming had had totally different new year plans. He had booked a flight to his home town in Zhejiang Province and had even bought some spicy local delicacies for his parents as new year gifts. “They are more accustomed to sweet food, but I want them to try something different,” he said.

Two days before his flight, Shen Ming got a text message from his boyfriend. “How are you?” the message read. “I got bad news: my father has been diagnosed with COVID-19. And my mother and I both have a high fever too. We are all on the way to the hospital and will stay there if there are beds for us.”

Shen Ming offered his condolescences to his boyfriend, and the next day went to see his doctor. He was relieved to be told that he was not infected, but was advised to stay in Wuhan for observation—he never thought that the coronavirus would be the reason for his first new year away from his family.

So, you are also HIV-positive, like us?

His first passenger was from Shanghai. Wuhan was put under lockdown just as he was about to leave. Soon, he found his HIV medicine running out. “If the medicine of people living with HIV is disrupted, their health will suffer. It might be inaccurate, but I can feel their fear, anxiety and dispair,” Shen Ming said.

Thanks to a directive from China’s National Center for AIDS/STD Control and Prevention, people living with HIV can receive medicine refills wherever they are. All they need is a letter from their service provider. However, they faced a challenge, as taxis and public transport services were stopped during the lockdown.

A survey jointly conducted by UNAIDS and the BaiHuaLin alliance of people living with HIV, a community-based organization in Beijing, shows that nearly 65% of the respondents in Hubei Province had difficulty getting their medicines during the lockdown. With most medical staff concentrating on COVID-19, community-based organization such as the Wuhan Lesbian, Gay, Bisexual and Transgender Center asked for volunteers like Shen Ming to transport people living with HIV to pick up their medicines.

On his first drive, Shen Ming put on three face masks and rolled down the car window to reduce the possibility of getting infected. His trip was to the same hospital that looked after people affected by COVID-19. He was nervous when arriving at the hospital, but to his relief the HIV clinic and the COVID-19 clinic were far apart. The Wuhan Lesbian, Gay, Bisexual and Transgender Center gave him a protective suit after learning that he didn’t have adequate protective equipment, and he eventually became more relaxed.

He would walk to the clinic with his passengers and wait there until they got their medicine. Afterwards, they would have a chat. “So, you are also HIV-positive, like us?” almost all of them would ask Shen Ming. He isn’t. “It doesn’t matter,” he said. “AIDS is just a chronic disease. The care for people living with HIV goes beyond the community of people living with HIV.”

“I will probably stay here”

It was late when he got back home after driving the three people to the hospital on the day of the Lantern Festival. Hungry, he turned on the hob and cooked noodles. This is the first time that Shen Ming hadn’t had sweet dumplings on the Lantern Festival, but he was happy because he got to meet his boyfriend, albeit briefly.

“I will continue my volunteering work until they don’t need me. It would be best if I’m not needed,” he said with a smile on his face.“I will probably stay in this city. I’ll buy a house when the epidemic is over, and build a home here.”

“People who inject drugs can access harm reduction services and HIV treatment, but they still don’t go for them. Why?” asked Deputy Director-General of Communicable Diseases of the Myanmar Ministry of Health and Sports, Thandar Lwin, while searching for ways to respond to the drug-related HIV epidemic in northern Myanmar.

One of the most affected regions is the northern most state of Kachin, where, according to government statistics, 72% of new HIV infections occur among people who inject drugs.

Bordering China on the east and India on the west, Kachin State reports the highest prevalence of HIV in the country, at 2.8%—the national HIV prevalence is estimated at 0.57%. The state is home to only 3% of the country’s population, but to 23% of all the people who inject drugs in Myanmar, whose HIV prevalence is more than 40%.

The reasons for such a concentrated epidemic among people who use drugs are varied. Mining, particularly for jade, illicit drug cultivation, production and trafficking, limited education and access to health services, and armed conflict are some of the obstacles to an effective response to the epidemic in the area.

Heroin and methamphetamine are widely available in towns and rural areas. The drugs are used by those who work long hours in mines and plantations, or for recreational purposes by children as young as 14 years, who can inject several times a day. 

In response, the government is providing HIV and harm reduction services at its health facilities and through a network of satellite clinics and drop-in centres run by nongovernmental organizations working with community health volunteers. Together, they provide, or refer people to, a wide range of services, including peer counselling, testing and treatment, needle–syringe programmes, opioid substitution therapy, condoms and treatment of sexually transmitted infections.

However, even with a government willing to support harm reduction services, the magnitude of the drug use problem is stretching capacity. Although there is political will, and financial resources are available, there is an urgent need to better understand the reasons why services are not always reaching the people who need them the most.

For that reason, a delegation led by the Government of Myanmar and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)—the biggest funder of the AIDS response in the country—together with the technical partners, UNAIDS and the World Health Organization, and the principal recipients, the United Nations Office for Project Services and Save the Children, visited the area to see how programmes are being implemented and to find alternative ways to effectively deliver services.

“Programming in this context requires partnership, collaboration and innovative approaches to ensure that the investments and activities have an impact in such a demanding environment,” said Izaskun Gaviria, Senior Fund Portfolio Manager at the Global Fund.

The visit showed that a good multipartner national response to HIV is producing results in parts of the country, but is falling short in areas affected by poverty and because of the availability of cheap drugs, a mobile population following seasonal work and long-standing ethnic conflicts. It also showed that policy changes are urgently required in order to improve access to opioid substitution therapy, antiretroviral therapy and other health services, including needles and syringes and naloxone for overdose management.

Fifty-nine per cent of people who use drugs in Myanmar were tested for HIV in 2016, rising to 74% in 2018. However, there is a gap between the number of people who test positive for HIV and the number of people who start on antiretroviral therapy. Many of the people either not initiating treatment or stopping are mobile seasonal workers, who come from within and beyond Kachin State.

The need for confirmatory HIV tests to be made at public health centres and the fact that people must have several mandatory counselling sessions before treatment can be initiated may also be contributing to the high percentage of people who test positive but are not yet accessing treatment. The Ministry of Health and Sports has issued a directive stating that all designated public sector services can initiate antiretroviral therapy. However, more reforms are required to bring health care to people who use drugs, who face legal challenges and, often, hostility in local communities.

The government has for a long time demonstrated a genuine interest in providing harm reduction services to people who inject drugs. Sterile needles and syringes can be obtained from health services run by nongovernmental organizations and rural drop-in centres, and some villages even have needle–syringe dispensers. However, the two syringes per user per day falls short of the actual daily injection average, and the needles and syringes are not distributed proportionally where the people who inject drugs live.

Furthermore, the fact that only public health facilities are authorized to provide opioid substitution therapy is hindering efforts to reach out to the people who need it. Transportation costs and remoteness are other obstacles to people who use drugs accessing their daily dose of methadone. Even the take-home dose, which the government is piloting among qualifying users, requires people to travel long distances to access it.

Perhaps the biggest challenge, however, remains the stigma and discrimination faced by people who use drugs and the resistance to harm reduction, especially needle–syringe programmes, at the local level from law enforcement agencies and faith-based antinarcotic drug groups in Kachin State. A lack of understanding of the concept of harm reduction, including the mistaken belief that the distribution of needles and syringes encourages drug use, is at the root of the stigma and discrimination. Police crackdowns and anti-drug operations by faith-based organizations contribute to driving people who inject drugs underground, away from harm reduction services.

The visit also brought to light an increasing hepatitis C epidemic among people who inject drugs. Testing for hepatitis C has revealed an estimated prevalence as high as 80% in at least one township among people who inject drugs. But despite this staggering percentage, there is currently no widescale hepatitis C treatment available. This, however, is something that the Global Fund is now considering to include in the next grant cycle following discussions with health officials and partners, together with an improved needle–syringe programme, the use of buprenorphine as an alternative to methadone and the introduction of pre-exposure prophylaxis. The United States President’s Emergency Plan for AIDS Relief is also contributing to funds for some of these innovations. But perhaps one of the most urgent improvements required is the creation of a unique code identifier, with sufficient safeguards for confidentiality, in order to provide patients with the treatment and services they need no matter where they are in the country.

Overall, and despite the many challenges, Myanmar is showing steady progress in its response to HIV thanks to a well-coordinated multipartner response. An extensive investment of resources by the Global Fund and other donors, as well as an increase in domestic funding, has led to a substantial scale-up of services across the country, which has resulted, according to the government, in the number of new HIV infections dropping by 31% from 2010 to 2018. Eighty per cent of people living with HIV in Myanmar know their status and the percentage of people living with HIV who have access to antiretroviral therapy rose from 1% in 2005 to 70% in 2018.

Nonetheless, the capacity of the government and nongovernmental organizations to deliver services seems to be reaching its limits. According to the UNAIDS Country Director, Oussama Tawil, “Key elements to expand the provision of services would include allowing task-shifting towards primary health-care providers, community health volunteers and the wider local community, improving linkages and integration of public and nongovernmental organization services and investing in human resources.”

The situation in Kachin State as well as other neighbouring states with similar characteristics, such as Shan North and Sagaing, has shown that there is an urgent need to adapt the AIDS response to specific locations and populations, but also that socioeconomic contexts have to be addressed for public health approaches to succeed. “Unless we address the underlying family livelihood issues and wider health consequences, and adapt to the local realities related to mining, economic interests and drug use, existing services won’t be enough,” said Mr Tawil.

There are around 45 000 people living with HIV in Papua New Guinea, with marginalized groups, such as sex workers and other women who exchange sex for money, goods and protection, gay men and other men who have sex with men and transgender women, most affected. However, less than half of the people who belong to those vulnerable groups have ever taken a test to know their HIV status.

In November 2018, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners implemented a new outreach programme in the capital, Port Moresby, to try to reduce the impact of HIV among those groups of people by mapping the HIV epidemic and expanding HIV treatment and prevention services. Under the project, several outreach teams were created to promote and increase the uptake of testing and prevention services and to link people to HIV prevention and care services, if necessary.

By April 2019, the outreach teams had contacted 5000 people and tested 3000 of them for HIV, offering advice and support so that each person understood their test result.

“I like that we go to new places where people have never been offered an HIV test,” said a member of one of the outreach teams. “My motivation is meeting the young girls and taking care of them—making sure they take their medication.”

The outreach workers sometimes face harassment while conducting their work and change out of their official uniforms and into their own clothes so that people feel more comfortable talking to them. But the outreach workers find the work deeply rewarding.

“I have lost friends to AIDS, so that keeps me doing this work,” said another of the outreach workers. “It makes me work extra hard not to see someone else lost to this disease.”

The outreach teams are led by members of marginalized groups, an essential part of establishing community trust and engagement. In addition, leaders offer coaching, support and advice to field workers on a daily basis in order to ensure that their activities are as effective as possible.

The outreach programme is saving lives. Another of the outreach workers recalled his work with a transgender person, who he persuaded to try medication after testing positive for HIV.  

“He told me that because he is transgender, he will only talk to a friend and that when he saw me, he knew I was a friend. Later, he brought in his companion to take a test.”

“This is a model of what can be achieved when we put our trust in community-led HIV services and programmes,” said Winnie Byanyima, UNAIDS Executive Director, in discussion with the outreach workers during her visit to Papua New Guinea with the United Nations Deputy Secretary-General, Amina Mohammed. “These outreach workers are heroes and they are saving lives.”

The outreach programme is also cost-effective and is projected to save hundreds of thousands of dollars over the next two years.

For six weeks, two teams covered 12 HIV clinics on a data checking mission in Papua New Guinea. UNAIDS joined the country’s strategic information technical working group in the National Capital District, which includes Port Moresby, to inspect the clinics’ records to see if they match the records of the National Department of Health.

“The data quality assessment is part of the country’s HIV monitoring and evaluation plan to ensure the quality of data and reporting of the AIDS response,” explained Zimmbodilion Mosende, UNAIDS Papua New Guinea Strategic Information Adviser.

Led by USAID, the two teams of 12 branched out into smaller teams to look at the number of people registered as enrolled on antiretroviral therapy, the number of people newly starting treatment, the percentage of people returning for refills and the number of people who did not return to the clinics. In addition, the groups checked information on, for example, the age and sex of each person.

The volunteers from civil society groups, international nongovernmental organizations, development partners and key government offices went through the records of nearly 5000 people.

Papua New Guinea has the highest HIV incidence and prevalence in the Pacific region. The country of 8.4 million people represents 95% of the reported HIV cases in the region. There are approximately 45 000 people living with HIV in the country, of whom 65% are on antiretroviral therapy.

The groups tried to find out if there are discrepancies in the data and the reasons behind them. Albert Arija, Monitoring and Evaluation Specialist of USAID, described the reasons for discrepancies, which range from there being an inadequate number of staff, hence not enough time to fill out all entries, to incorrect data entry or at times misinterpretation of information. For fear of stigma and discrimination, some clients don’t want to give personal information.

One key missing data point was also birthdates. “Many people in Papua New Guinea cannot recall their exact date of birth,” said Mr Arija.

The technical working group is advocating for the use of electronic forms and real-time reporting. “Since the current antiretroviral therapy forms are still paper-based, there are several potential data quality risks, including human errors, from the data entry and processing,” Mr Mosende said.

Overall, most of the clinics had good quality data and processing, according to the teams’ assessment. They hope to simplify the overall process to scale up the data check for the whole country.

The Pacific region has among the world’s highest rates of gender-based violence. National research show that 72% of Fijian women experience gender-based violence, compared to the global average of 35%. Women in the region also have a low representation in leadership positions—out of the 560 Pacific members of parliament, 48 are women, of whom 10 are Fijian women.

Adding to these sociocultural impacts is the climate emergency. In response, Pacific women are demanding more involvement in climate-related decision-making and to be fully engaged in climate responses.

Komal Narayan, a Fijian climate justice activist, became fascinated during her postgraduate programme in development studies about how climate change overlapped with ethics and politics. “The effects of climate change are felt most acutely by the people who are least responsible for causing the problem,” she said. This motivated her to be more active and vocal about the issue, leading to her participation, together with other young delegates from Fiji, in the twenty-third United Nations Climate Change Conference, held in Bonn, Germany, in 2017.

“My goal in life is to be part of a society that is focused on addressing the issues of climate justice and encouraging and motivating more young people to be more involved in this space, as I believe that this issue is not just yours or mine but an issue that is at heart for the entire Pacific,” Ms Narayan said.

Ms Narayan was also one of the Green Ticket Recipients for the United Nations Youth Climate Action Summit in September 2019, where she was involved in a youth-led dialogue with the United Nations Secretary-General.

“As givers of life, as dedicated mothers, thoughtful sisters, domestic influencers and active contributors to socioeconomic development, we women have the power to give impetus to the global climate movement,” Ms Narayan said. “It’s about time that women and girls are given equal opportunities and equal access to resources and technology to be able to address climate justice. Countries, specifically government and civil society, should be playing a key role in this.” 

AnnMary Raduva, a year 11 student at Saint Joseph’s Secondary School in Suva, Fiji, believes that climate justice must recognize the connection between humans and the environment and how vulnerable we are if we don’t do something today.

“In the Pacific region, our indigenous communities depend intimately on the ecological richness for subsistence, as well as economically, and this dependence makes our people sensitive to the effects of extreme weather events, and we cannot ignore them. We have a close relationship with our surroundings and are deeply spiritual and culturally connected to the environment, and ocean, and this relationship has positioned us to anticipate, prepare for and respond to the impacts of climate change,” Ms Raduva said.

In 2018 she wrote to the Fijian Prime Minister asking him to relook at the Fiji Litter Act 2008 to classify balloon releasing as littering in Fiji. Ms Raduva soon realized that talking about balloon releasing was not enough, however, and that she had to find eco-friendly alternatives to amplify her message. The idea of planting mangroves along the Suva foreshore soon came to her.

Since 2018, she has initiated six planting activities and has planted more than 18 000 mangrove seedlings. She was invited to New York, United States of America, in September 2019 to march for climate justice at a United for Climate Justice event organized by the Foundation for European Progressive Studies. She stood in solidarity with the indigenous communities that are on the forefront of climate change as it advances in the Pacific region.

Ms Raduva has faced discrimination as a young female activist and has been mocked as a “young, naive girl”. She was told that she must not talk about climate change because activism is reserved for boys and adults. However, she believes that ensuring the participation of women, children and lesbian, gay, bisexual, transgender and intersex people and other minority groups in climate change talks is a priority for any institution or organization that aims to champion climate change issues.

Varanisese Maisamoa is a survivor of Cyclone Winston, which in 2016 was one of Fiji’s most powerful natural disasters. In 2017, she formed the Rakiraki Market Vendors Association, working with UN Women’s Markets for Change project—“We want to empower our market vendors to be climate-resilient,” she said. Through UN Women’s leadership training, she learned to be confident when speaking out about the issues affecting market vendors and to negotiate with the market council management.

Ms Maisamoa represented her association on the design of the reconstruction of Rakiraki’s market, which now features infrastructure resilient to a category 5 cyclone, a rainwater harvesting system, flood-resistant drainage and a gender-responsive design.

Ms Narayan, Ms Raduva and Ms Maisamoa are among the Pacific women who are pushing for more of a voice in and inclusiveness for women and girls in climate action. Their activism is working to reduce discrimination against women and girls, which results in inequalities that make them more likely to be exposed to disaster-induced risks and losses to their livelihood, and to build resilience for women to adapt to changes in the climate.

Ms Maisamoa’s story has been republished with permission from UN Women’s Markets for Change project, which is a multicountry initiative towards safe, inclusive and non-discriminatory marketplaces in rural and urban areas of Fiji, Solomon Islands and Vanuatu that promotes gender equality and women’s economic empowerment. Implemented by UN Women, Markets for Change is principally funded by the Government of Australia, and since 2018 the project partnership has expanded to include funding support from the Government of Canada. The United Nations Development Programme is a project partner.

People who use drugs are often highly stigmatized and face high levels of discrimination. Women who use drugs, however, are doubly stigmatized and discriminated against—because of their drug use and because of their gender. They are also more exposed to gender-based violence and human rights violations that put them at risk of HIV and other infections.

Worldwide, few harm reduction programmes tailor their services to meet the needs of women, and gender-based discrimination may make them unwelcoming. HIV-related services also often don’t cater for the needs of women who use drugs.

As part of efforts to reach out to women who inject drugs, the India HIV/AIDS Alliance is working with the Punjab Government, through its Ministry of Health and Family Welfare at the Civil Hospital in Kapurthala, to develop a comprehensive harm reduction model for women who inject drugs in Punjab.

The hospital is developing a holistic and person-centred approach through a harm reduction clinic that provides services tailored to meet the needs of women. Employing a one-stop shop approach, HIV and harm reduction services are present in one facility. Clients are provided with a range of options, including opioid substitution therapy, needle–syringe programmes and naloxone, an effective treatment for opioid drug overdoses, which they can access free of charge at a time that suits them the best.

“When we didn’t have our women’s harm reduction centre, accessing opioid substitution therapy from other centres was a real challenge. The male users harassed us for sexual favours,” said Preeti Singh (not her real name), a client of the clinic.

The clinic works in partnership with local nongovernmental organizations to ensure that women who inject drugs can access other services, including counselling, HIV testing and sexual and reproductive health services. A menu of gender-sensitive services has been developed that draws on experience from India and other Asian countries. Women are service providers, community mobilizers and beneficiaries of the project.

“Initially my husband and my in-laws did not allow me to go access opioid substitution therapy from the women’s harm reduction centre. Now that I am on antiretroviral therapy and healthier, they know it works!” said Kiran Sharma (not her real name), a client of the clinic.

The project is also focusing on the creation and strengthening of community forums, organized by the State Drug User Forum together with the India HIV/AIDS Alliance. The forums aim to gather information from the perspective of the women themselves, to understand and respond to cross-cutting issues, including gender-based violence and stigma and discrimination, as well as to strengthen the delivery of HIV and harm-reduction services.

“Like my peers, I also went to the centre for seeking help with my withdrawals, and I was surprised to find many services for girls like us. What I like most was that there was help to take care of my child,” said Monica David (not her real name), a client of the clinic.

Started in February 2019, the project has already attained its target of reaching 150 women who inject drugs. The clinic has had a dramatic impact on the women’s lives, improving awareness about HIV, hepatitis C and tuberculosis prevention and testing and linking them to further treatment and care based on their need.

The project will be assessed later in the year and the evidence used for introducing and scaling up the model in India and elsewhere in Asia.

The UNAIDS Country Director for India, Bilali Camara, said that the project is timely. “We must continue to work collectively to close the gaps that continue to leave behind women who use drugs. Ending the AIDS epidemic as a public threat by 2030 depends on advancing a social justice and inclusion agenda that demands access to integrated health services free from discrimination, with the meaningful involvement of the communities,” he said.

“I was walking to work, like I do every morning. There was a man on a motorbike at the end of the street. As I walked pass him, he grabbed my breasts and sped off.” This is a quote from one of the many stories featured on Hollaback! Jakarta’s website.

Sexual harassment and other forms of gender-based violence remain a serious issue for women in Indonesia. According to the National Commission on Violence Against Women’s Annual Report, there were more than 400 000 reported cases of violence against women in 2019, of which 28% were in public spaces. Public facilities, public transport and streets have become places where women do not feel safe and secure.

Hollaback! Jakarta is part of the global movement to end harassment in public spaces. In its quest to create safer spaces for women in the city, Hollaback! Jakarta works with ride-hailing app companies, public transport services, schools and campuses to provide training on gender-based violence.

“By training motorbike taxi drivers, they are not only able to understand forms of harassment, but also take an active part in intervening against harassment they see in public spaces,” said Noval Auliady, Co-Director of Hollaback! Jakarta. In Jakarta, where streets are filled with motorbike taxis, this is incredibly important.

Currently, women do not have full legal protection from gender-based violence. While there are laws that exist, gaps still remain. The Draft Bill on the Elimination of Sexual Violence was set to fill the gap, with an expanded definition of sexual violence and a focus on protection and victim restitution.

For several weeks in September 2019, students, activists and young people took to the streets of major cities in Indonesia to demand the passing of the draft bill. Hollaback! Jakarta was part of the core team for the campaign, creating a social media buzz, mobilizing people and meeting with parliamentarians.

Unfortunately, the draft bill was not passed in the last parliamentary sitting as conservative groups strongly argued against the clauses on the criminalization of marital rape. It is notable that the bill is still included in this year’s priority list of the national legislation programme. The massive support from civil society groups for the bill does increase its likelihood of passing and brings hope to the fight for ending gender-based violence in Indonesia.

The Internet has become a great ally for the movement. Not only was social media vital in mobilizing people to support the draft bill, it has also been a powerful platform to spread the important message of ending violence against women.

On its website, Hollaback! Jakarta encourages people to share their stories, showing how widespread, serious and familiar experiences of violence are for women. Like the quote above, people share personal experiences and some share cases they have witnessed as bystanders.

The Hollaback! Jakarta website has posted more than 300 stories of women experiencing various forms of gender-based violence, from catcalling to abuse. With each story posted, others can show their solidarity by clicking “I’ve got your back”. With its website and social media presence, Hollaback! Jakarta recognizes the potential to create a virtual safe space for women experiencing such issues.

“The more stories there are, the more people are willing to speak up and show their support. More bystanders are willing to intervene when seeing it first-hand. This is what we hope to achieve,” said Mr Auliady.

GENEVA, 19 February 2020—A survey of people living with HIV has found that the current coronavirus disease outbreak, known as COVID-19, is having a major impact on the lives of people living with HIV in the country.

In the survey, nearly a third (32.6%) of people living with HIV reported that, because of the lockdowns and restrictions on movement in some places in China, they were at risk of running out of their HIV treatment in the coming days—of these, almost half (48.6%) said they didn’t know where to collect their next antiretroviral therapy refill from. However, a close partnership between the government and community partners is determined to ensure that access to life-saving HIV treatment is not interrupted as the country fights to get COVID-19 under control.

The Chinese National Center for AIDS/STD Control and Prevention has directed local authorities to ensure that non-resident people living with HIV can collect their medication wherever they are and has published and disseminated lists of antiretroviral therapy clinics. The UNAIDS China Country Office is working with the BaiHuaLin alliance of people living with HIV and other community partners to urgently reach those people living with HIV who are at risk of running out of their medicines in the next 10–14 days and will offer support as necessary. UNAIDS will also be donating personal protective equipment to civil society organizations serving people living with HIV, hospitals and others to help improve the quality of care for people in health facilities and to prevent coinfection of people living with HIV with COVID-19.

“People living with HIV must continue to get the HIV medicines they need to keep them alive,” said Winnie Byanyima, UNAIDS Executive Director. “I applaud the efforts of the Chinese National Center for AIDS/STD Control and Prevention to support people living with HIV affected by the lockdowns to get their medicines—we must ensure that everyone who needs HIV treatment gets it, no matter where they are.”

The COVID-19 outbreak in China has resulted in an unprecedented response, resulting in hospitals and health-care workers being overwhelmed as they look after COVID-19 patients. Lockdowns in cities have resulted in people living with HIV who had travelled away from their hometowns not being able to get back to where they live and access HIV services, including treatment, from their usual health-care providers.

While the vast majority of the respondents (82%) said that they had the information they need to assess personal risk and take preventive measures against COVID-19, almost 90% said that they wanted more information on specific protective measures for people living with HIV. Similar to the general population, many of the respondents (more than 60%) said that they didn’t have enough personal and household protective equipment, such as face masks, soap or disinfectant, medical alcohol or gloves. Nearly a third reported being anxious and needing psychosocial support during the COVID-19 outbreak.

“We need to know how many people living with HIV are contracting COVID-19, whether people living with HIV are at greater risk of contracting COVID-19 and, if they contract it, whether they are in greater danger from it—at this stage of the COVID-19 outbreak there are so many unknowns. We must fill in the gaps in our knowledge, and fill those gaps in rapidly,” added Ms Byanyima.

The survey was devised and launched jointly by UNAIDS and the BaiHuaLin alliance of people living with HIV, with the support of the Chinese National Center for AIDS/STD Control and Prevention. UNAIDS mobilized community support for the survey and promoted the survey online in order to maximize the responses to it—more than 1000 people living with HIV replied. Responses were collected from 5 to 10 February 2020. A follow-up in-depth survey is to be carried out in partnership with the School of Medicine at Zhongshan University, which will go beyond community needs and will look at health systems issues that have a direct impact on HIV services.

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.

Boy Somjai and Jam Chainukul (not their real names) are a young same-sex couple from Bangkok, Thailand. At the start of their relationship, they decided to take HIV tests for the first time. Looking for information online, their friends suggested the Rainbow Sky Association of Thailand (RSAT), a community-based HIV clinic located off a busy street in Bangkok.

RSAT, with four clinics and 10 drop-in centres in different cities across Thailand, serves as a one-stop service where gay men and other men who have sex with men and transgender people can access HIV prevention services and take part in HIV-related information sessions, with flexible service hours suitable for the lifestyles of many people from key populations.

Danai Linjongrat, the Executive Director of RSAT, said, “Access to HIV services for key populations is among the biggest challenges to the HIV response in the country. It is extremely important that key populations can access HIV prevention and treatment services without fear of discrimination.”

Mr Boy and Mr Jam, who now return to RSAT every three months for regular check-ups, said, “When we first visited the clinic, we were really nervous, as we were looking for a place that respects our confidentiality. Here we found more than an HIV clinic—we found a place we can trust, like a family. The health staff made us feel comfortable to share our story; they did not judge us and they understood our needs with an open mind.”

The success of RSAT is credited in part to its health workers being members of the populations they serve. RSAT has adopted the country’s key population-led health services model, in which people from key populations identify and meet the HIV and other health-related needs of their peers. “We understand the needs of our clients, what they want, where they live and how they feel, because our staff members are people from the communities,” says Mr Linjongrat.

Community health workers provide needs-based and client-centred services, including pre-exposure prophylaxis (PrEP), legal consultations, harm reduction, screening for sexually transmitted infections, counselling and hormone level check-ups for transgender people. Depending on the outcome of a person’s HIV test, they are offered a referral for antiretroviral therapy or an in-depth discussion about taking PrEP, all in a non-judgemental and supportive atmosphere.

RSAT is one of seven community-based organizations in Thailand that provide PrEP services free of charge through lay providers under the Princess PrEP Project. Currently, 1200 people are accessing PrEP through RSAT clinics and drop-in centres. The Thai Red Cross AIDS Research Centre, with the support of the United States President’s Emergency Plan for AIDS Relief through the LINKAGES Thailand project, implements continuous capacity-building to ensure that community health workers can provide HIV services in accordance with national standards.

RSAT uses different ways to generate demand for and promote its programmes and to carry out outreach work. Phubet Panpet, Deputy Director at RSAT, said, “Depending on our target audience, we go to different places, such as saunas, entertainment complexes, schools and universities, to raise awareness about HIV prevention and encourage people to get tested for HIV.”

Kunpawee Isalam, a staff member of the outreach team in Bangkok, is a transgender person who understands the stigma and discrimination faced by the transgender community. “We plan outreach activities that we know transgender people will be interested in, with the aim of increasing their self-confidence. For many, it is so hard to feel they can get support, and they fear discrimination. RSAT provides a safe space and HIV prevention options,” she said.

RSAT uses social networking sites to reach out to young gay men and other men who have sex with men. Staff members register as users and create profiles on dating applications to share HIV-related information. “At the beginning of the conversation, the outreach worker explains about the clinic and engages people in a conversation related to HIV prevention,” said Mongkol Jaidee, a field officer. “I choose the location, see who is connected, and send them personal messages to introduce the services provided by the clinic. I normally receive positive feedback, and it is common for people to come back later with questions and visit us in the following days.”

Mr Linjongrat concluded, “We differ from other services by caring for people by looking into what they need and what we can do to help them. Community-led services are a proven strategy and an essential feature of the HIV response in Thailand.”

There are approximately 24 000 young people aged 15–24 years living with HIV in Thailand. In 2018, young people accounted for nearly half of the 6400 new HIV infections in the country.

Thailand has made great strides in its AIDS response, providing antiretroviral therapy free of charge as part of its universal health coverage scheme. However, adolescents and young people living with HIV often fall out of care or do not receive the support they need to remain on treatment. Self-stigma, stigma and discrimination and transition from paediatric care to adult care are some of the challenges faced by adolescents and young people living with HIV.

To close this gap, three years ago the United Nations Children’s Fund (UNICEF) and other national partners led by the Thai Network of People Living with HIV created the Thai Network of Youth Living with HIV. The main objective was to empower adolescents and young people living with HIV to be agents of the change that they wanted to see in their lives. The network’s capacity was built to provide referral services, life-skills training and peer-to-peer support for adolescents and young people living with HIV.

Kritthanan Ditthabanjong, one of the first active members, is now Head of Corporate Communication at the network. Studying to become a journalist, he also works as a content editor for websites and magazines in Thailand and is a well-recognized young leader. Mr Ditthabanjong represents the network at public events and in the media, voicing the needs of young people living with HIV.

“I have publicly disclosed my HIV-positive status because I want other people to learn from my experiences and to give young people the information they need to lead healthy and dignified lives. I feel confident to speak out because I have support from my friends and community,” he said.

With technical and financial support from UNICEF and other partners, and through a variety of platforms and strategies, the network offers emotional support around receiving an HIV-positive diagnosis, provides HIV information to reduce self-stigma, builds coping skills and creates a supporting network to tackle stigma and discrimination. “Young people living with HIV need emotional support and a community they can trust,” said Mr Ditthabanjong.

Trained young leaders with the network provide counselling for young people living with HIV and link them to health facilities, hospitals and community-led services for HIV treatment and care. The young leaders also accompany young people living with HIV to medical appointments and carry out follow-up home visits to help them adhere to treatment.

The network uses social media to reach out to young people, providing information on HIV and promoting self-acceptance. Initiatives such as the online campaign Growing Up with HIV offer safe spaces that enable young people to ask questions about different topics, including HIV prevention and safe sex, and share opinions and thoughts.

“Growing Up with HIV allows young people to be part of our community and make them feel they are not alone,” continues Mr Ditthabanjong.

Mr Ditthabanjong engages in other campaigns and social media initiatives with UNICEF that address young people in general in Thailand but also allow him to bring in the voices and perspectives of young people living with HIV. He has recently joined Dare to Dream, a public campaign created by UNICEF for Thai young people to voice their opinions on education and what is required to prepare them for the transition to adulthood. “From a shy adolescent who did not wish to speak and constantly glanced at his counsellor for approval a few years ago, Mr Ditthabanjong followed a path with us and he was one of nine motivational speakers at the Dare to Dream youth campaign, a role model for young people in his country,” said a UNICEF staff member.

Mr Ditthabanjong concludes, “One day I had an interview on social media. As soon as I came off, I received a text from a young person who had recently been diagnosed with HIV. “My mum and dad do not accept me, and I want to kill myself,” he said. I phoned him, met him and convinced him to join our network. Now this person is doing well. Our work is impacting people’s lives.”