Everyone will have experienced stigma and discrimination of some kind during their lives; however, non-discrimination is a human right. As part of UNAIDS' work to achieve zero discrimination, UNAIDS encourages people to speak up and prevent discrimination from standing in the way of achieving ambitions, goals and dreams.

Two UNAIDS ambassadors recently took part in a dialogue with students at Peking University about the need to achieve zero discrimination to end the AIDS epidemic and ensure better health for all.

The First Lady of Panama, Lorena Castillo de Varela, UNAIDS Special Ambassador for AIDS in Latin America, and the famous actor and humanitarian, Huang Xiaoming, UNAIDS Goodwill Ambassador for China, spoke about their commitment to reducing stigma and discrimination at an event on 24 April. The dialogue was opened by the Vice-President of Peking University, Zhan Qimin.

During the lively discussion between the two ambassadors, the First Lady encouraged young people to integrate their antidiscrimination efforts into their everyday actions. “Just that smile, even though it might look very small to you, it can make another humanbeing feel special, not discriminated or different,” said Ms Castillo.

Discrimination has many forms, from racial or religious discrimination to discrimination based on gender, sexual orientation or age, and to bullying at school or at work. In only three out of 10 countries worldwide do equal numbers of girls and boys attend upper secondary school, and people living with disabilities are nearly three times more likely to be denied health care than other people.

Ms Castillo stressed that the important role that the young generation has to play in taking the lead. “I want to use this platform to send messages to all the universities in the world, they should all follow your lead too, and give voices to those who have no voices, be the voice for them, let them know that there’s somebody somewhere sending them love, fighting for them.”

Mr Huang explained what had motivated him to start working on zero discrimination and become a UNAIDS Goodwill Ambassador. “I had seen children who suffered from discrimination related to HIV. Their inner repression, touched me and made me start to think about how I could help them. Of course discrimination is not limited to just children. So when I learned that UNAIDS had the goal of ending AIDS worldwide by 2030, I was very excited and willing to do my best for this goal.”

A piece of advice to young people from Mr Huang moved everyone in the meeting hall: he quoted a line from the film Wonder, "When given the choice of being right and being kind, choose kind—I believe it is important to be kind to everyone, it’s particularly important to keep our minds clear and objective, and to uphold justice and truth".

Ran Wei, a representative of UNAIDS, thanked the two ambassadors for their tireless efforts championing zero discrimination and urged students to follow their lead. “It is not only a responsibility, but also a privilege for youth, to fight for a world that’s healthy, just and free from discrimination,” she said.  

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

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

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

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

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

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

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

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

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

Shiv Kumar, from Swasti Health Catalyst in India, decided to build a mobile and web application called Taaras (rapid progress). He had watched peer educators work with sex workers in Bangalore, India, and realized that he could make their jobs a lot simpler and more efficient. The south-east Indian city has become a major hub and, as a result, the population has boomed, as have sex workers. 

After seeing outreach workers, mostly former sex workers, lugging notebooks and jotting down information and recalling appointments and treatment pickups, he created an app that helps with data collection. “Icons and swipes allow outreach workers to enter all sorts of stuff and swipe and pick up where they left off,” Mr Kumar said. They can also text multiple recipients with reminders and invitations.

“Outreach can no longer be a one-way street. You have to engage the patient,” he said.

The app rolled out in five Indian states in English as well as four regional languages. Since its debut in March 2016, there are now more than 400 users following about 120 000 sex workers.

Bangalore outreach worker Natranity said that she has a lot less paperwork to deal with. “All the data of a particular person is now in one place, versus five or six registers that I had to consult,” she said. Her colleague, Abdul, agreed, “I see about 10 to 15 people a day and what saves me a lot of time is not asking the same questions over and over again, because I can consult their profile.”

The phones had their limits, they explained. “At the initial stage, it’s important to build trust to avoid any discomfort in case they think we are taking photos or recording them,” Natranity said. 

Prachi Patel, a technology developer at Swasti, sees Taaras as a bridge to an overall solution. “The app is a helper; outreach workers still do all the talking,” she said. A by-product of the app has been higher engagement with sex workers and an increase in reporting incidents of violence. For confidentiality, the app has a stress password that scrambles the data in the event that someone tries to access the information. 

UNAIDS Senior Adviser Philippe Lepère commends such efforts and believes e-health has a huge potential. Not only can it strengthen health systems, it also empowers people to manage their own care. Referring to the World Health Organization’s Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, he said that they advocate using text messages to remind people to take their treatment and encourage newly diagnosed people to seek out services.   

For this to work, however, he stressed the importance of confidentiality and respect of the user. “Receiving an HIV-related SMS can have drastic consequences in some communities,” he explained. That's why, he said, the content and the frequency have to be ironed out beforehand. “Most importantly, it’s urgent to shift from pilot studies to a larger implementation of programmes at a sufficient scale that can then be integrated within health systems,” Mr Lepère said. 

“In certain countries, digital apps have flooded the market and the government has no way of accessing the data or doing any quality control,” he said. 

Hani Eskandar, from the International Telecommunications Union, definitely sees mobile phones as paving the way towards universal health coverage.

But, in his view, e-health systems are far from a reality. “Countries have not yet grasped the benefits of this, because they are still focused on vaccines and building hospitals rather than outreach,” he said. He is pushing for governments to rebuild infrastructures that integrate digital platforms.

“It's simple,” he said. “We need for mentalities to change at all levels and stop thinking that the phone is just a gadget.” 

Experts from India and around the world recently discussed new ways of carrying out HIV surveillance and making estimates on the HIV epidemic in India.

Opening the consultation, the Director General of Health Services of India, B.D. Athani, said, “Disease surveillance is the stethoscope of a public health professional and an extremely important public health function.”

The consultation heard about in-country pilot projects and other initiatives being planned. Steps being taken to strengthen the quality of data and enable their better use were highlighted, as were efforts that are being made to improve the interface between the various information systems for HIV surveillance.

Technical sessions on HIV surveillance, including the importance of integrated surveillance for HIV, tuberculosis, hepatitis and syphilis, and on making HIV estimates were held throughout the four-day event.

“The use of data is fundamental to enabling an efficient and sustained public health response. Three questions remain critical in this regard: what data shall be collected, how it shall be collected and how it should be used to help the design and implementation of an effective response,” said S. Venkatesh, the Deputy Director General of the Indian National AIDS Control Programme.

During a session on making district-level HIV estimates, the different methods of how estimates could be made were examined. The participants agreed that, for inter-district comparability and consistency, just one method should be used to generate district estimates. Determining the best method would require further analysis of the strengths and limitations of all of them, however.

During the consultation, Bilali Camara, the UNAIDS Country Director for India, noted the importance for the AIDS response of having granular information on locations and populations.

A presentation on key population size estimates included a novel pilot for virtual mapping using social media in an ethical and cost-effective way, which was recognized as the methodology of the future. The consultation also heard that India should collect behavioural information through so-called polling booth surveys—whereby information on behaviours can be collected anonymously—and other innovative approaches.

Sessions on each of the technical areas began with international experts sharing the broad global framework and guidelines. They highlighted approaches adopted by different countries and the practical considerations for each approach. The participants agreed that data from surveillance, estimates and programmes represent different pieces of information that together provide a better perspective on the HIV epidemic and response—each piece is important and should not be seen in isolation.

The consultation was held on 21–24 March in New Delhi, India. It was organized by India’s National AIDS Control Organization in collaboration with UNAIDS, the World Health Organization and the United States Centers for Disease Control and Prevention, whose experts were joined by national experts from the Indian Council of Medical Research institutes and others. Recommendations from the consultation will be compiled into a road map for implementation by the National AIDS Control Programme.

UNAIDS is saddened by the news of the sudden death of David Cooper on 18 March. He was a pioneering HIV researcher, immunologist and professor at Australia’s University of New South Wales and in 1986 became the first Director of the National Centre of HIV Epidemiology and Clinical Research, now known as the Kirby Institute. 

Mr Cooper diagnosed the first documented case of HIV in Australia in the mid-1980s, and in 1991 was named Chair of the WHO Global Programme on AIDS’ Committee on Clinical Research and Drug Development.

He was a past President of the International AIDS Society and worked with colleagues to found the HIV Netherlands Australia Thailand Research Collaboration, known as HIV-NAT, in Bangkok, Thailand.

“The world has lost a bold and compassionate leader in the response to HIV,” said Michel Sidibé, UNAIDS Executive Director. “David Cooper firmly believed in health as a fundamental human right. Without the groundbreaking research and advances in treatment that he helped to make a reality, many more lives would have been lost to AIDS. Our thoughts during this difficult time are with his family, colleagues and the many people his life and work touched.”

In commemoration of Zero Discrimination Day, the UNAIDS China Country Office has launched an audio adaptation of the award-winning children’s book The bravest boy I know.

The book tells the story of the heart-warming friendship between Xiao Ming, an eight-year-old living with HIV, and his best friend Xiao Li, sending the critical message that with treatment and support from families, friends and schools, children living with HIV can have a normal and happy childhood, and that children living with HIV have the right to a life free from discrimination, as other children do.

The audiobook was launched on 6 March in Beijing, China, by Huang Xiaoming, the renowned actor and UNAIDS Goodwill Ambassador for China. The aim of the new audiobook is to disseminate the message of zero discrimination among a younger audience. A short video also catering to the needs of children comes with the audiobook, both of which are available to download for free.

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UNAIDS and the Government of Australia have signed a new five-year strategic partnership agreement to advance efforts to respond to HIV in the Asia–Pacific region. The agreement will focus on promoting evidence-informed, sustainable and integrated approaches to responding to HIV that promote innovation and address human rights, discrimination and gender issues.

The agreement highlights a shared vision to end AIDS and builds on the strengths and experiences of both Australia and UNAIDS to form a collaborative partnership. This partnership will enable a robust and sustainable response to HIV which is integrated into the wider context of health and sustainable development in the Asia–Pacific region.

As part of the agreement, Australia will commit AUD 22.5 million (US$ 17.1 million) to UNAIDS over five years from 2018 to 2022 to support UNAIDS in achieving the targets, goals and vision outlined in the UNAIDS Strategy: On the Fast-Track to end AIDS.  

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The International Symposium on the Prevention and Control of HIV in China was held in Beijing, China, on 13 and 14 November to discuss China’s evolving HIV epidemic. The symposium was sponsored by China’s National Health and Family Planning Commission and the Ministry of Science and Technology, with the support of UNAIDS, the World Health Organization and the United States Centers for Disease Control and Prevention.

The meeting aimed to put forward new strategies for preventing HIV through sexual transmission. Wang Guoqiang, Vice-Minister of the Chinese National Health and Family Planning Commission, opened the meeting by underlining China’s commitment to HIV prevention. Luiz Loures, UNAIDS Deputy Executive Director, commended China for its political commitment to the HIV response and for innovations that include a unique platform for financing civil society organizations to support prevention efforts.

In the early 2000s, people who inject drugs were at the highest risk of HIV in the country, but a harm reduction programme that started in 2006 rapidly expanded opioid substitution therapy. According to the Chinese National Center for AIDS/STD Control and Prevention, China’s free and voluntary opioid substitution therapy programme is now the largest in the world, cumulatively serving about half a million people over the past 10 years. Government data show that HIV prevalence among people who inject drugs has declined to an estimated 6% in 2015 from more than 12% in 2005.

Public health data from China suggest that gay men and other men who have sex with men are emerging as the group most affected by HIV. According to government data, less than half of gay men and other men who have sex with men know their HIV status and consistent condom use in the past six months has remained at around 45% for a number of years. One innovation has been the active role of community-based organizations, which have actively provided services to their peers with the support of local hospitals. However, other interventions that studies have found to be effective, such as the use of self-testing and pre-exposure prophylaxis, are still at the research stage in China.

The participants of the symposium presented the Chinese government with preliminary recommendations on how to strengthen HIV prevention and control in China, which include shifting the focus to a stratified 90–90–90 target. The recommendations also include increasing resources to community groups and moving forward more aggressively beyond effectiveness and efficacy studies to large implementation and cost-effectiveness studies. Removing institutionalized stigma and discrimination, particularly in health-care settings, was emphasized as a vital component of success.

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The Ministry of Public Health of Thailand has launched its new 2017–2030 National AIDS Strategy, which provides a road map for ending the AIDS epidemic as a public health threat in Thailand by 2030. Narong Pipatanasai, Deputy Prime Minister and Chair of the National AIDS Committee, led the launch at the Government Complex in Bangkok, Thailand, on 13 September.

The 13-year plan adapts the latest global commitments to Thailand, ensuring an effective, cost-efficient and high-impact HIV response. A recent UNAIDS report on the global AIDS epidemic finds that annual new HIV infections dropped by 50% in Thailand between 2010 and 2016, the steepest decline for any country in the Asia and the Pacific region.

During the launch, 19 representatives of ministries and government offices signed a commitment to end AIDS. Deirdre Boyd, United Nations Resident Coordinator for Thailand, congratulated the government on the strategy and Apiwat Kwangkaew, the Vice-Chair of the Thai Network for People Living with HIV, stressed the need to ensure there is no stigma towards people living with HIV, so they can access key services. The Deputy Prime Minister acknowledged that government agencies cannot effectively reach key populations without the support of community groups. He said that while he had not seen important collaboration between key partners in response to other diseases, collaboration was a hallmark of the HIV response.

The strategy’s goal is to further reduce new HIV infections from 6500 to less than 1000, cut AIDS-related deaths from almost 13 000 to under 4000 and reduced HIV-related discrimination in health-care settings by 90% by 2030.

The new strategy commits to a Fast-Track phase, where an all-out effort is made to reach the global 90–90–90 targets by 2020, whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment are virally suppressed. Thailand has already achieved the first 90.

The country’s epidemic is concentrated among key populations, including men who have sex with men, transgender people, people who inject drugs and sex workers. With the new plan, the government commits to supporting combination prevention programmes for key populations and working in partnership with community-led organizations to reach people at higher risk in the locations where they live and work. The strategy gets to the subnational level, tailoring programmes to specific populations in specific locations. It also plans to increase the integration of HIV health services with hepatitis C, tuberculosis and other infectious diseases. 

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UNAIDS and the Ministry of Health of Malaysia have launched a joint web platform that aims to strengthen the generation of strategic information and the use of national, subnational and key population data for evidence-informed programming.

The platform, which is hosted and supported by the UNAIDS regional data hub, was launched by Noor Hisham Abdullah, Director-General of Malaysia’s Ministry of Health, and Eamonn Murphy, Director of the UNAIDS Regional Support Team for Asia and the Pacific, at the 5th Asia Pacific Conference on Public Health, which ended on 13 September in Kuching, Malaysia.

Malaysia has made significant progress in its response to HIV. This progress has been due to the strategic investments the country has made in making services available for key populations, including people who inject drugs, men who have sex with men, transgender people and sex workers.

Health authorities recognize the key role that data and strategic information play in the achievements they have made, but underline that the HIV epidemic is constantly changing and that there is a need to track the virus. The new partnership will ensure that up-to-date strategic information helps to set evidence-informed priorities and a quick response to the evolving dynamics of the country’s HIV epidemic.

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