Networks of key populations and community-based organizations in China have called for strengthened collaboration to improve and increase access to Internet-based HIV prevention services.

At the Seminar on Social Organization’s Involvement in Internet-Based HIV/AIDS Prevention, held in Chengdu, China, more than 60 representatives of 45 community-based organizations came together for two days to discuss how to utilize technology and innovations to support the HIV response. In particular, they explored how HIV prevention services can reach a wider range of people and how to encourage key populations to get tested for HIV and initiate treatment if needed.

With the Internet increasingly being used as a source of health information, its potential for delivering HIV prevention services is significant, especially given that services can be delivered anonymously and with minimal cost.

In 2018, according to the government there were 1.25 million people living with HIV in China: 69% of those were aware of their HIV status and 83% of those were accessing treatment. The HIV epidemic in China is concentrated among key populations, particularly among gay men and other men who have sex with men.

Yuan Jizheng, from the Chinese Foundation for Prevention of STD and AIDS, recognized the significant role that Internet companies play in HIV prevention, especially corporations that serve the lesbian, gay, bisexual, transgender and intersex community, such as Blued, the world’s largest gay dating app. “Companies should continue to advocate for protected sex and HIV prevention and testing, including counselling for key populations and care and support for people living with HIV,” she said.

With more than 8 million active monthly users, apps such as Blued play an important role in promoting HIV services on the Internet among gay men and other men who have sex with men. Such services provide information on HIV prevention through chat room outreach, online partner notifications, online test slips, banner ads, interactive targeted interventions and websites, focusing on populations at higher risk of HIV, including gay men and other men who have sex with men, adolescents and young adults.

Danlan Goodness, a community-based organization affiliated with Blued, launched the Internet + HIV Response initiative four years ago to provide online and offline HIV prevention and treatment services for gay men and other men who have sex with men. Since its inception, 150 community-based organizations from 90 cities in China have joined the platform to provide HIV prevention services through Blued’s new media channels.

The UNAIDS Country Office for China has been working closely with Danlan Goodness to conduct research on Internet-based HIV prevention service strategies for young people and key populations in order to understand better how online services can help to improve service delivery. The research looks at the benefits of Internet HIV prevention services, such as the low cost of delivering content, the ability to reach hidden populations, the potential to erase geographic and social barriers caused by stigma and marginalization and the relative anonymity it provides in seeking information and support online.

“The research findings will be shared with community-based organizations and other related partners to facilitate capacity-building and policymaking in this area,” said Liu Jie, the Community Mobilization Adviser for the UNAIDS Country Office for China.

“The importance of Internet HIV prevention interventions has been magnified during the COVID-19 pandemic, when conventional HIV testing and treatment services were disrupted,” said Kong Lingkun, the President of the Beijing Love without Borders Fund and Chairman of the U = U Anti-AIDS Network of China. “Community-based organizations are willing to work with the government and the private sector, tapping into the potential of Internet HIV prevention interventions to benefit more people,” he added.

At the seminar, community-based leaders and participants exchanged ideas about the challenges and advantages of Internet HIV prevention services, sharing views on overcoming specific difficulties such as data privacy and confidentiality, Internet inaccessibility and ways to enhance cooperation between community-based organizations and the government, international organizations and private corporations.

The forum was co-organized by the Chinese Foundation for Prevention of STD and AIDS, Danlan Goodness, Blued, the UNAIDS Country Office for China, the Chengdu Tongle Social Work Service Centre, the China AIDS Fund for Non-Governmental Organizations and the Sichuan Association of STD and AIDS Prevention and Control.

“Communities must be allowed to sit in the driver’s seat and take control of their lives. They are not passengers that sit idle, but leaders capable of making changes,” said Aditya Wardhana, the Executive Director of the Indonesian AIDS Coalition (IAC). This is the motto that he lives by, a motto that drives the work of IAC and how communities and civil society are meaningfully engaged in the HIV response in Indonesia.

IAC is a community-led organization based in Jakarta and was recently appointed the second community Principal Recipient to implement the Global Fund to Fight AIDS, Tuberculosis and Malaria’s (Global Fund) grant for HIV in Indonesia for 2022–2023—a feat, since only a handful of community-based organizations nationally or regionally hold Global Fund Principal Recipient status.

“Often, communities are seen as beneficiaries of programmes or as patients, not as decision makers. The IAC has always strived to shake up this dynamic. We believe that being a Principal Recipient will give us greater control over the issues that impact our communities and will set the direction of the national HIV response that puts communities at the centre of it,” explained Mr Wardhana.

In Indonesia, there are still significant gaps in the HIV response. Treatment coverage is low, with only 26% of people living with HIV on treatment, prevention is still lagging and stigma and discrimination remains high. IAC has identified three priorities to improve the HIV response in Indonesia, which include recognizing community health workers as health workers, creating more sustainable financing to reduce reliance on external donors and reforming laws and policies that discriminate and lack redress mechanism for victims of discrimination.

Networks of people living with HIV deliver life-changing services to those most affected and provide support for adherence to treatment, prevention and other essential health services. The involvement of civil society has been crucial in successfully advocating for sustainable financial resources, improving HIV programming and advancing human rights.

Over the next couple of years, IAC will work on these priority issues with the support of civil society organizations, United Nations partners and other stakeholders. IAC will continue to manage the human rights and community system strengthening programme, supported by the Global Fund and the Ministry of Health. Community system strengthening and community-led monitoring are integral parts of the HIV response. The programme ensures that community-based organizations play an active role in monitoring access to services, community programme quality assurance and human rights violations.

Since the organization’s foundation, the UNAIDS Country Office for Indonesia has been an ally and key partner, supporting IAC throughout the Principal Recipient selection process. “We know how important the role of communities is at all levels of the HIV response. We will continue to support IAC by providing technical assistance and capacity-building, working in collaboration to promote the meaningful engagement of communities and civil society in the HIV response,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

IAC, with support from the United Nations Population Fund in Indonesia, will soon establish a peer-led HIV prevention programme for female sex workers, offering differentiated service delivery to increase the uptake of HIV prevention services. Through the programme, they will also empower communities through capacity-building initiatives to drive the greater involvement of civil society in decision-making, especially in forming policies that directly impact the health and well-being of communities and vulnerable populations. Moreover, IAC plans to integrate gender-based violence screening into its outreach programmes. A human rights-based approach is essential to ending AIDS as a public health threat. This approach will create an enabling environment for successful HIV responses and affirms the dignity of people living with or vulnerable to HIV.

IAC will be responsible for managing US$ 17 million to implement the above programmes, with eight organizations across Indonesia as subrecipients.

“We will dive deep into these challenges and hopefully change the landscape of the HIV response. We believe that a more participatory approach will re-energize communities and remind them why HIV is still important and how programmes designed by communities for communities can save lives. This is what we will work towards; this is how we will end AIDS by 2030,” said Mr Wardhana. 

ACON, one of Australia’s largest HIV organizations, working to promote HIV prevention strategies among gay men and other men who have sex with men in New South Wales, Australia, has recently launched a new campaign video that enlists some of Asia’s most popular social media influencers.

The campaign aims to raise awareness and promote the uptake of pre-exposure prophylaxis (PrEP), particularly among Mandarin-speaking gay men and other men who have sex with men. The campaign addresses frequently asked questions about PrEP and features Fufu and Josh, also known on social media as FJ234, YouTube personalities with a following of 350 000 subscribers. The pair appear alongside a leading doctor and PrEP advocate, Stephane Wen-Wei Ku, who in the campaign breaks down information on PrEP through relatable and humorous conversations.

“PrEP is a good tool to protect yourself, even if you are not ready to talk about sex with your partner. So, we could all have a great sex life without worrying about HIV,” Josh and Fufu explained.

In Asia and the Pacific, civil society organizations in countries such as Thailand and the Philippines have turned to social media platforms and other innovative solutions to offer new ways to link communities to PrEP and other prevention options. For example, in Thailand, the PrEP in the City campaign, launched by the Institute of HIV Research and Innovation and supported by the UNAIDS Regional Support Team for Asia and the Pacific and other key partners, aimed to increase PrEP uptake among transgender women by challenging negative perceptions. Likewise, in the Philippines, civil society organizations used innovative programmes to deliver antiretroviral therapy to clients, and PrEP and condoms were frontloaded to community champions for distribution.

“Raising awareness of PrEP, which is an extremely effective strategy for preventing HIV transmission, is fundamental to our efforts in eliminating the virus,” said Nicolas Parkhill, the Chief Executive Officer of ACON, reflecting on the critical role of the campaign in scaling up PrEP among Mandarin-speaking gay communities in New South Wales.

PrEP has had an enormous impact on HIV transmission rates in New South Wales and Australia as a whole since it was first made available in 2016 through various state-based trials, and later in 2018 when it was subsidized under the national Pharmaceutical Benefits Scheme. Currently, there are three main ways to access PrEP in Australia. The most common is through the Australian health-care system at a subsidized cost. Other options include purchasing PrEP from a pharmacy using a private prescription from a doctor or purchasing it from a reputable pharmacy and importing it into Australia under the Personal Importation Scheme. These last two options are particularly important for people who are not covered under the Australian health-care system, such as international students.

“PrEP is now the most commonly used HIV prevention strategy for gay men, but if we are to realize its full potential on reducing HIV transmission in New South Wales, we need to break down barriers and ensure that PrEP is easily accessible to all men in every community. By working with Fufu, Josh, Stephane Wen-Wei Ku and Hotline, we hope the video will be able to help raise awareness and show how effective it is, how easy it is to get and its benefits,” Mr Parkhill added.

The campaign video was developed in partnership between ACON and the Taiwan Tongzhi Hotline Association, a sexual health organization. A vital feature of the campaign was that the content was developed with the Mandarin-speaking community, so that the messaging is authentic to Mandarin-speaking men. The video is available in Traditional and Simplified Mandarin, with English subtitles.

“To close the gaps and ensure that no one is left behind, we must foster innovation and scale up access to HIV prevention and treatment services. Strong national commitment to scale up PrEP, adopting national PrEP policies and guidelines, setting ambitious PrEP targets and allocating sufficient resources for PrEP will help countries across the region to get the HIV response back on track. We have the tools to end AIDS. Now we must use them,” said Eamonn Murphy, Director, UNAIDS Regional Support Team for Asia and the Pacific.

COVID-19 continues to threaten the gains made in the HIV response and has brought inequalities to the forefront, but civil society and community-based organizations in Asia and the Pacific have been quick to respond to the pandemic. From the start, networks of people living with HIV and key populations responded to the global health crisis by coming up with innovative courses of action.

A side event organized on the margins of the United Nations High-Level Meeting on AIDS showcased best practices of community-led responses to COVID-19 and HIV prevention in Asia and the Pacific.

It was noted that, since the onset of the COVID-19 pandemic, key population networks have rapidly mobilized volunteers and partners to assist people affected by COVID-19, ensured the continuity of HIV services and found new ways to adapt to the new normal with online-based interventions.

For example, the Asia Pacific Network of Sex Workers responded to the pandemic by modifying its existing programmes to meet the urgent needs of the sex worker community, such as by reallocating funds to subsidize transport costs for sex workers living with HIV to ensure their access to HIV treatment services.

Other regional networks, such as the Asia Pacific Transgender Network, the Asia Pacific Network of People Living with HIV and Youth LEAD, established emergency relief funds to provide emergency food supplies, housing and rent, transport, protective gear, including personal protective equipment, masks, sanitizer and sanitary products for the most affected communities.

In several countries, community-led organizations of people who use drugs delivered door-to-door provisions of antiretroviral therapy and harm reduction services, including opioid substitution therapy and sterile needles and syringes. These experiences have been compiled by the Asia Pacific Network of People who Use Drugs in a best practice report to advocate for the full and equal participation of people who use drugs within the HIV response.

The panellists also heard about the Australian Federation of AIDS Organisations, which in its national and community-led responses has been supporting community-based HIV testing, working directly with clinics run by the community for the community. Also, APCOM, a regional network for gay men and other men who have sex with men based in Bangkok, Thailand, implemented a condom promotion campaign during the COVID-19 pandemic, known as #PartyPacks, where key populations can order online (for free) packages containing condoms, lubricant and information on harm reduction.

The speakers agreed that service delivery needs to be modernized, domestic investment should be increased and services led by key populations should be integrated into national health systems.  

The panellists highlighted that dealing with the colliding pandemics of HIV and COVID-19 requires working in unison and solidarity.

Quotes

For Vanessa Chaniago, a young transgender woman living in Jakarta, Indonesia, the first few months of the COVID-19 pandemic were filled with fear. “I was really struggling to make ends meet. I had been working for a civil society organization, which was a great place to learn and develop strong networks, but unfortunately the income was not sufficient to sustain me and my family. My income drastically declined,” she said.

According to a survey conducted by the Crisis Response Mechanism (CRM) Consortium of 300 lesbian, gay, bisexual, transgender and intersex (LGBTI) people in Indonesia, the COVID-19 pandemic has caused most LGBTI people to have experienced layoffs or reductions in income or to close their businesses. Most LGBTI people work in sectors with a higher risk of COVID-19: 20.5% in the beauty industry, 19.5% in the health sector and 12.8% in the service industry. Unfortunately, most of the respondents do not have long-term savings—30% would only be able to survive for two to three months on their savings, and 64% are not able to access loans.

Reflecting back on more than a year of the pandemic, Ms Chaniago said that the situation didn’t rapidly improve and instead got more challenging as time went on. “I decided to start a small business, selling beef rendang and other Indonesian street food. Opening a business during the pandemic wasn’t ideal, and not long after the opening I had to close down my store. Now I continue my small business on the streets.”

Ms Chaniago is determined to survive these trying times and she recognizes that many of her fellow transgender women face bigger hurdles. Many transgender people in Indonesia do not have identity cards, leaving them unable to access social support from the government. The CRM survey found that 51% of respondents did not receive social support from the government and those that tried to receive it faced many challenges in accessing it.  

On top of the socioeconomic struggles they face, discrimination and violence towards the LGBTI community continues—transgender women in Jakarta have even been pranked with aid packages filled with garbage. The CRM survey also found that violence against LGBTI people increased.

Keeping in touch virtually among the community has been essential. Ms Chaniago said, “I want to tell my fellow LGBTI peers that they are not alone. As a community, we must continue to help each other out and fight for what is right.” Unfortunately, the CRM survey found that the community cannot always turn to peers for support, as many don’t have devices or enough Internet data to contact their friends.

Despite the huge hardships, there is a strong sense of optimism and hope for a better life after the pandemic. To get there, however, the LGBTI community needs support, including form the government and the public.

“Everyone has been affected by COVID-19. In Indonesia, many vulnerable groups have struggled to survive not only the pandemic but the devastating impact of loss of livelihoods and income. UNAIDS works with partners to strengthen the protection of vulnerable groups from stigma and discrimination in order to increase equitable access to support and services,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

The CRM Consortium consists of UNAIDS Indonesia and four national civil society organizations—Arus Pelangi, the Community Legal Aid Institute, Sanggar Swara and GWL-Ina. In addition to the survey, the CRM Consortium has mobilized resources for LGBTI people affected by the pandemic through the distribution of food packages, sanitation packages and rent allowances.

The results of the survey are highlighted in a video here.

The HIV response in the Philippines has been hit by the COVID-19 pandemic, especially access to HIV prevention and treatment services. According to the Global Fund to Fight AIDS, Tuberculosis and Malaria, in Metro Manila coverage of HIV prevention services for gay men and other men who have sex with men has decreased by 74% since 2019. Government figures show that compared to 2019, in 2020 HIV testing decreased by 61% and enrolment in HIV care reduced by 28%. The COVID-19 pandemic has drawn attention to socioeconomic divides, highlighting failures within the health system to adequately deal with not one pandemic but two. 

Despite this, what has been clear from the onset of the COVID-19 outbreak is that civil society and communities have stepped up to the challenge to provide HIV services while navigating through restrictions on movement and lockdowns. One example is the Family Planning Organization of the Philippines (FPOP), a civil society health service provider and advocate of sexual and reproductive health and rights with a network of more than 1000 community-based services across the country. One of those service providers is the Rajah Community Center, a primary HIV clinic located in Iloilo City in the Western Visayas region of the Philippines, which provides HIV services for key populations, including young key populations, in a friendly and stigma-free environment. 

“When I tested positive for HIV, I knew nothing about it. I did not know how to protect myself from it and talking about sex was taboo in my house. My friends and I were clueless about condoms,” said Jhenard Jude, a young person from Iloilo City. After receiving his positive diagnosis, Mr Jude learned about the Rajah Community Center. “I heard from my friends that Rajah provides youth-friendly services. I was worried about how others would look at me because of my status, but the staff at the clinic were non-judgemental and very friendly. I was given a care worker who supported me every step of the way to access antiretroviral therapy,” he said.

“This is home to me. I got my HIV self-test kit here in June 2020. Rajah is safe and convenient,” said Lloyd Legario, a young person who regularly visits the clinic for HIV testing and prevention services. 

Winnie Byanyima, the UNAIDS Executive Director, has been learning about the Rajah Community Center during a two-day virtual mission to the Philippines to engage with communities, civil society and the government about the country’s response to HIV and COVID-19. During her virtual visit, Ms Byanyima was given a pre-recorded tour of the community clinic and had an open dialogue with Mona Liza S. Diones, the Chapter Program Manager of FPOP Iloilo, Robert Figuracion, the Rajah Community Center Clinic Officer, and three clinic clients from key populations.

“I had the pleasure to speak with some very courageous people who were very open about their experiences at the Rajah Community Center. I extend my deepest gratitude and solidarity to community-based organizations and frontline workers for stepping up and providing essential services during COVID-19,” said Ms Byanyima.

To ensure the continuity of HIV services during COVID-19, FPOP Iloilo worked closely with the Philippines Department of Health, local government units and other treatment hubs and support groups to serve key populations and people living with HIV. Blended services that included online counselling and onsite services covered prevention commodities, testing services, treatment and medical care. This also included providing psychosocial services, which have seen a sharp rise in demand since the first COVID-19 outbreak. Telemedicine and mobile clinics became new channels for differentiated care. Innovative programmes to deliver antiretroviral therapy to clients were established and pre-exposure prophylaxis (PrEP) and condoms were frontloaded to community champions for distribution.

During the virtual visit, Ms Byanyama also learned about the HIV & AIDS Support House (HASH), another renowned community-led service provider, which in coordination with the Department of Health has worked to prevent disruption to HIV services during COVID-19. HASH offers community-based screening, PrEP, HIV referral services, medical assistance to children living with HIV and psychosocial support to key populations. “Civil society organizations were quick to respond to the situation by coming out with innovative courses of action, such as online counselling, alternative modes of antiretroviral therapy delivery and mobilization of volunteers and partners to assist those who were affected by the COVID-19 pandemic,” said Desi Drew Ching, the President of HASH. 

“To sustain community-led services, government and development partners have to optimize collaborative partnerships with civil society. This will strengthen their leadership capacities and enhance civic space funding through social contracting programmes,” said Louie Ocampo, the UNAIDS Country Director for the Philippines.

By Nandini Kapoor, Community Support Adviser, UNAIDS Country Office for India

The death of Smarajit Jana has left us shaken. True to his nature, he fought COVID-19 valiantly, but sadly the champion for the response to HIV succumbed to the coronavirus.

How do you begin to describe Mr Jana? A medical doctor, a public health specialist, an epidemiologist, a researcher and academician, an ardent advocate for the response to HIV and the architect of India’s national HIV response for key populations, a champion of human rights and the dignity of sex workers, the founder of the Durbar Mahila Samanwaya Committee (DMSC) collective of sex workers, a winner of national and international honours and accolades, a distinguished voice in domestic and global forums, and much more.

A great leader, an incomparable professional and, above all, a human being par excellence, he gave voice to the most vulnerable and the most marginalized to ensure they were heard and their dignity respected. He touched innumerable lives. Words are not enough to capture the range of his work and the difference he made to so many lives. What he did is etched in the hearts of the lives he touched—with warmth, with love, with affection.

He was a man of science, with his heart firmly anchored in the community he served. He brought science to the community level simply and brilliantly. And the reverse was true—he could easily translate policy and science in simple words for the community to understand.

I first met Mr Jana when I joined UNAIDS 18 years ago. We had organized a meeting for key populations and invited representatives of DMSC, since it had been key to the sex worker movement in India. We were told that they would attend, but not without Mr Jana, their guide, mentor and father figure. That was the level of trust and confidence they had in him. He spoke for their rights and ensured that the reality in the field was brought to the meeting table.

His skill at listening to the community and overlaying what he heard with policy discourse helped to move community-friendly strategies as part of the national HIV response. His presence at every meeting was full of energy and passion.

I have had several conversations with Mr Jana on a range of programmatic issues—the changing nature of sex work, preexposure prophylaxis, collectivization, decriminalization and much more, and each conversation was a learning experience for me.

I will miss him, above all his sage counsel and mentoring. But he will live on—in the work that he did and in the hearts of the vast numbers he impacted.

Our prayers are with his family and the thousands of people whose lives he touched and made better. Om Shanti.

More than 150 civil society representatives from 17 countries in Asia and the Pacific joined the first virtual regional consultation on the upcoming United Nations High-Level Meeting on AIDS.

“Your views are important. We need them, and they really matter for the success of the political declaration,” said Mitch Fifield, Australia’s Ambassador and Permanent Representative to the United Nations and one of the two co-facilitators for the high-level meeting process, in his opening remarks. He also spoke about the valuable contributions of the participants to the high-level meeting and the critical role of communities in the HIV response.

The consultation was an opportunity for civil society organization leaders to take stock of the progress made and the challenges facing the HIV response in the region. It fostered cross-sharing of different expectations of the high-level meeting, allowing civil society organization representatives to share what they see as important for inclusion in the political declaration and to collect inputs to be shared with the multistakeholder task force in preparation for the multistakeholder hearing.

Asia and the Pacific has the second largest regional epidemic after Africa, with 300 000 new HIV infections in 2019. Key populations and their partners accounted for an estimated 98% of new HIV infections, and more than one quarter of new HIV infections were among young people (aged 15 to 24 years). At present, in Asia and the Pacific 160 000 people die from AIDS-related illnesses every year because they do not receive life-saving treatment in time, or the quality of care is insufficient. Nearly 2.3 million people living with HIV, or 40%, are not on treatment, signifying a need to increase treatment coverage.

The participants at the consultation stressed that the new political declaration should give prominence to the scale-up of HIV prevention and treatment efforts, including pre-exposure prophylaxis, self-testing, harm reduction services, same-day antiretroviral therapy, multimonth dispensing and comprehensive sexuality education. Strengthening health systems and the integration of HIV services with other health services, such as services for mental health, sexual and reproductive health, and tuberculosis, is seen as a priority for the next five years to ensure that no one is left behind. “To end AIDS, we must ensure universal, free and sustainable access to prevention and treatment services. The political declaration should be built on the last milestones, especially the Declaration on Universal Health Coverage,” said a civil society organization leader.

Community members recognized that policy and legal barriers, including the criminalization of sex work, consensual same-sex sexual relations and drug use, are deterring people living with HIV and key populations from accessing health services and undermining efforts to end AIDS. “Sex work and drug use are not crimes but a part of life for many. This should be strongly stated in the political declaration,” said one participant. Key population leaders made a strong statement about removing harmful laws, policies and practices towards key populations. They highlighted the need to strengthen the legal and policy environment to protect key populations and vulnerable groups from stigma, discrimination and violence. 

Current investments in the HIV response in the region reflect inadequate HIV financing, particularly for key population programming. Civil society organization leaders agreed that to ensure the sustainability of HIV programmes, increased political commitment for domestic funding and financing for communities and key populations programmes are critical. “Investments in HIV must be anchored on the principles of equity, social justice and accountability. These should include investments to support people-centred approaches to health service delivery where services are differentiated but integrated,” said another community representative.

The participants also considered the impact of the COVID-19 pandemic on communities in the region. The diversion of resources and health workers to respond to the more immediate COVID-19 pandemic presents a real risk, threatening the hard-fought-for gains of the HIV response. “We should ensure that the focus on HIV remains strong while dealing with COVID-19, and regular HIV services and uninterrupted supply of antiretroviral therapy should be guaranteed,” said a community leader. Communities also stressed the importance of a new political declaration that considers how COVID-19 has impacted community-led responses to HIV. “There should be financial commitments, a crisis fund or financial safety networks for key populations because they suffered immensely during the COVID-19 pandemic,” one participant said.

Throughout the consultation, the first and foremost demand has been for inclusiveness of key populations in decision-making. “If key populations and people living with HIV are not included in the highest level of decision-making, we will never end inequalities,” said another participant.  “Empowerment of communities is integral to strong and resilient health systems. It is important to enable the meaningful engagement of civil society organizations at all levels of programming, including policy development, service delivery, monitoring and evidence-generation,” said another participant.

The main points from the consultation will be synthesized into a regional civil society statement that captures the main priorities and demands of communities for the 2021 political declaration. Likewise, recently, UNAIDS Asia–Pacific launched a social media campaign to encourage key actors, governments, donors, stakeholders, civil society, academics and influencers to make their voices heard in the lead-up to the high-level meeting on the needs and priorities of the HIV response in Asia and the Pacific.

The UNAIDS Regional Support Team for Asia and the Pacific convened the consultation in collaboration with Sonal Mehta, the Regional Director of the International Planned Parenthood Federation South East Asia, and Jules Kim, of the UNAIDS Programme Coordinating Board nongovernmental organization delegation and Scarlet Alliance, representatives of the multistakeholder task force for the high-level meeting from Asia and the Pacific.

The President of Afghanistan, Mohammad Ashraf Ghani has joined world leaders and experts in an appeal for equitable and fair distribution of COVID-19 vaccines.

In a letter to the People’s Vaccine Alliance, President Ghani outlined that despite the numerous challenges Afghanistan continues to face as a country caught in conflict, Afghanistan has witnessed fewer human losses caused by the COVID-19 pandemic compared to other countries. However, the President underscored that this did not mean that the resulting implications were underestimated or ignored.

“We must put in place all possible efforts to maximize the supply of vaccine so that everyone, everywhere can benefit as quickly as possible,” said President Ghani. “I assure you of my unwavering support to the People’s Vaccine Alliance.”

In the letter he urges fellow leaders to urgently develop a common plan to massively scale up manufacturing of the vaccine. Which would not only save millions of lives, but also build capacity and infrastructure in countries around the world to manufacture medicines and vaccines to help achieve universal health coverage and prepare for future health emergencies.

He also urged fellow leaders—especially leaders in high-income countries—to insist that the vaccine technology and know-how is shared through the World Health Organization's Covid-Technology Access Pool, and that leaders unite to strongly support the proposal made by India and South Africa to the World Trade Organization to waive patents during the pandemic.

The President of Afghanistan joins more than 150 leaders and advocates globally who have signed up to be part of the People’s Vaccine Alliance including the President of South Africa and the Chairperson of the African Union Commission, the Presidents of Ghana and Senegal, the Prime Minister of Pakistan, the Director of the Africa Centres for Disease Control and Prevention and the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

“EMERGENCY and all the members of People Vaccine Alliance advocate for equal access to the vaccines: while millions of people who have already been vaccinated in the United States, the United Kingdom or European countries feel safer, most of the low-income countries will barely be able to vaccinate one out of 10 people in 2021 due to the inaccessibility of vaccines,” said Rossella Miccio, President of EMERGENCY.

The People’s Vaccine Alliance calls on pharmaceutical corporations and governments to:

• Prevent monopoly on vaccine production by making public funding for research and development conditional on research institutions and pharmaceutical companies sharing all information, data, biological material, know-how and intellectual property. The WHO COVID-19 Technology Access Pool provides the mechanism for such sharing.
• Prevent monopoly on vaccine supply by enabling as many manufacturers as possible, including in developing countries, to produce the vaccines.
• Implement fair allocation of the vaccine that prioritizes health workers and other at-risk groups in all countries. Vaccination programmes should include marginalized groups, including refugees, prisoners and people living in slums and other crowded housing conditions. Allocation between and within countries should be based on need and not ability to pay.
• Provide the vaccine free of charge at the point of use.
• Ensure the full participation of the governments of developing countries as well as global civil society in decision-making forums about the vaccines (and other COVID-19 technologies) and ensure transparency and accountability of all decisions.

The People’s Vaccine Alliance

The People’s Vaccine Alliance is a coalition of organisations and activists united under a common aim of campaigning for a People’s Vaccine’ for COVID-19 that is based on shared knowledge and is freely available for all. A global common good. It is coordinated by Oxfam and UNAIDS and its other members include: EMERGENCY, Free the Vaccine, Frontline AIDS, Global Justice Now, International Treatment Preparedness Coalition, Just Treatment, Nizami Ganjavi International Center, Open Society Foundations, STOPAIDS, SumOfUs, Wemos and Yunus Centre.

The global health emergency caused by the COVID-19 pandemic has brought existing inequalities to the forefront, has exposed transgender and gender-diverse communities to a heightened risk of social exclusion, stigma and discrimination, has reduced access to health care and has caused financial insecurity.

“COVID-19 has created an existential threat to many transgender people in Asia and the Pacific. But trans-led organizations and groups have found creative ways to assist their communities, to offer support against social isolation and to support trans and gender-diverse people, especially those unable to work due to COVID-19. We recognize the importance of trans leadership and their response to communities greatly affected by the pandemic,” said Joe Wong, Executive Director of the Asia Pacific Transgender Network (APTN).

When COVID-19 reached India, Maya, a young transgender woman living with HIV volunteering at Basera Samajik Sansthan, a transgender-led community-based organization in Uttar Pradesh, was living in rented accommodation after being rejected by her family. “During the COVID-19 outbreak, my friends and I had to leave our homes because we couldn’t afford the rent,” she said. Basera Samjik Sansthan provided her and her friends with shared accommodation and supplied them with food and medicine. The community-led organization also established a peer support programme to help homeless transgender young people and provide them with hand sanitizer, masks and access to free HIV and COVID-19 testing.

Her testimony is part of a collection of stories published in Dignity amidst COVID-19: Trans Youth Leading The Response, developed by APTN and Youth LEAD, and supported by the UNAIDS Regional Support Team for Asia and the Pacific, to bring visibility to the voices and experiences of transgender and gender-diverse youth leaders and showcase the efforts of transgender-led organizations throughout the region during COVID-19.

“Many transgender people living with HIV were not able to afford transportation to medical centres to receive treatment during the COVID-19 outbreak,” said Della, a young transgender woman living with HIV from Indonesia who works for the Srikandi Sejati Foundation, whose testimony is also collected in the Dignity amidst COVID-19 series. The Srikandi Sejati Foundation established a community support programme that covered transport costs to medical centres to ensure that transgender people could access HIV services. It also implemented local workshops to support and empower transgender women in five districts in Jakarta with knowledge on COVID-19, HIV, mental health and adherence to antiretroviral therapy.

In Thailand, measures taken to curb the spread of COVID-19 and the consequent decline in tourism have forced many entertainment shows and venues to close, leaving many transgender people out of work. “The decline in tourism has heavily affected not only businesses but sources of income for transgender people. Many trans women have returned to rural areas to be with their families due to loss of employment,” said Garfield, a young transgender woman working for the Sisters Foundation, a transgender-led organization in Pattaya that provides a range of HIV services to transgender people, including check-ups for general health, HIV and sexually transmitted infections, hormone therapy and harm reduction. As described in the collection of stories, since the beginning of the pandemic, Garfield and other volunteers have been at the forefront of the COVID-19 relief efforts, distributing food supplies and hygiene products to transgender women.

Basera Samajik Sansthan, the Srikandi Sejati Foundation and the Sisters Foundation are all beneficiaries of the COVID-19 Community Support Fund established by APTN to support transgender people and community-based organizations to ease the burden of the COVID-19 pandemic in the region. APTN provided grants to 22 transgender-led and transgender-inclusive community groups and organizations across 14 countries, enabling them to assist more than 2300 people across Asia and the Pacific. The grant supported various initiatives, including access to essential supplies, food and personal protective equipment, social and mental health relief support, financial assistance and funding support to sustain organizations.

The community-led initiatives and outcomes of the response to COVID-19 are summarized in the Trans Resilience Report—Stories of Hope, Pain, and Survival from the Trans Movement during the COVID-19 Pandemic, developed with financial support from the UNAIDS Regional Support Team for Asia and the Pacific, and in APTN’s multi-week social media campaign.

“On International Transgender Day of Visibility, UNAIDS recognizes the indispensable contributions made by transgender communities in the HIV and COVID-19 response. The leadership and resilience of transgender and gender-diverse communities continues to be an inspiration for our region,” said Eamonn Murphy, Director of the UNAIDS Regional Support Team for Asia and the Pacific. UNAIDS will continue to work with APTN and transgender-led organizations to work towards a region where transgender people and gender-diverse people can thrive as equals.