In the Philippines, the Mayor of Pasig City, Vico Sotto signed a declaration of commitment to implement the Fast-Track Cities Initiative (FTCI), which aims to scale-up the response to the growing HIV epidemic in the context of the COVID-19 pandemic.

Pasig City will proactively deliver quality services to everyone, including hard-to-reach populations, by increasing investments to scale-up HIV programs, establishing more treatment facilities and integrated social hygiene clinics, and training more healthcare providers to deliver HIV and COVID-19 services.

UNAIDS will provide technical support in the implementation of the strategy to ensure that efforts at the local level are strengthened to respond to COVID-19 and HIV, including scale up of testing and zero discrimination programmes for healthcare providers.

Learning from the HIV response, Pasig City is one of the cities that is providing COVID-19 testing to its residents, has introduced a loan program to revitalize the economy of small and medium enterprises, and established quarantine facilities providing food and medical care and other essential needs.

In Fiji, UNAIDS donated cleaning equipment and gardening tools to an income generating project initiated by Survival Advocacy Network Fiji (SAN Fiji) to support the needs of sex workers who are facing hardships during the COVID-19 pandemic including loss of income.

SAN Fiji, an advocacy organization for the rights of sex workers, has been working with other organizations such as Strumphet Alliance Network, Haus of Khameleon and UNAIDS to implement income generating initiatives for sex workers including catering, grass-cutting services and general backyard cleaning.  

The UNAIDS Country Office for the Islamic Republic of Iran and the country’s branch of the International Federation of Medical Students’ Associations have been collaborating on new ways of making an impact on the national AIDS response since 2013.

In the past, the collaborations have included public awareness campaigns, educational workshops, field visits and week-long summer schools open to health-care students.

“The summer schools were more than inspiring, they made us confident about our next area of focus: acting against HIV-related stigma and discrimination,” said Aidin Parnia, one of the founders of the summer schools and of the Avecene Consultancy.

Started by people who had attended the summer schools, the Avecene Consultancy was formed to mobilize the accumulated knowledge and experience of the summer schools and to combine them with modern and up-to-date educational developments. The result is the REDXIR educational online platform, which uses games to change the attitude and behaviour of health-care students in order to bring about a future generation of discrimination-free health-care professionals.

Set in an imaginary world where the players are a young group that battles a mysterious enemy that symbolizes HIV-related stigma and discrimination, the goal of REDXIR is to fight back and defeat stigma and discrimination.

The 10 levels of the game are designed to challenge the students’ knowledge of HIV and their attitude and behaviour towards people living with the virus. For example, in the Blood Pressure level of the game, the students have to take the blood pressure of a person living with HIV to show that he or she can do so without discrimination. At higher levels, they should be able to take a blood sugar test and a blood sample for a routine laboratory test.

While some of the levels are performed virtually, others need action to be taken in the real world. For example, in the Do Not Be Silent level, the students must recognize discriminatory posts on social media, post #Zerodiscrimination below at least one of the social media feeds they see and comment on the reason why the content is discriminatory. In the Campaign level, the students participate as trainers in an HIV awareness campaign.

“New generations need new platforms. REDXIR, through its user-friendly approach where students are in direct contact with the target populations, has proved to be an effective way to help eliminate HIV-related stigma and discrimination in health-care settings,” said Parvin Kazerouni, the Head of the HIV Control Department of the Center for Communicable Disease Control of the Iranian Ministry of Health and Medical Education and the National AIDS Manager.

“REDXIR shows how creative and innovative approaches can embrace and support the novel ideas of young people to address issues such as stigma and discrimination,” said Fardad Doroudi, the UNAIDS Country Director for the Islamic Republic of Iran.

The UNAIDS country office provided technical and financial support for REDXIR. 

When the Thai government ordered the closure of entertainment venues in the country in March, it didn’t just signal an end to pulsating music and rounds of drinks shared with friends. It also signalled the start of difficult times for an estimated 145 000 sex workers living in Thailand.

Initially, Service Workers in Groups (SWING), a Thai national organization providing HIV services and advocating for sex workers’ rights, received requests from sex workers for the most basic of needs—food. As requests began flooding in, it became clear that without a source of income many sex workers were unable to cover the cost of daily expenses, housing and medicine.

“When the COVID-19 outbreak began, nobody was talking about sex workers, and no measures were in place to help them,” said Surang Janyam, Director of SWING.

Spurred by growing concerns about how the outbreak has impacted the lives of sex workers, SWING, in collaboration with Planned Parenthood Association Thailand and Dannok Health and Development Community Volunteers, with support from UNAIDS, launched a community-led rapid assessment of 255 sex workers from Bangkok, Pattaya and Dannok and community-based organizations throughout the country.

The outbreak has had a severe socioeconomic impact on the lives of sex workers, further exacerbated by the lack of social protection measures. According to the findings from the rapid assessment, 91% of respondents became unemployed or lost their source of income following the start of the COVID-19 outbreak. Three quarters of the respondents could not make enough money to cover daily expenses and 66% could no longer cover the cost of housing.

Ms Janyam spoke about the difficulties faced by sex workers and how the priorities for SWING’s work have shifted. “As a sex worker-led organization, we cannot provide only HIV services while sex workers are hungry and lack the basic needs to survive,” she said. She explained that many of the sex workers expressed that they were not eligible for the government assistance of 5000 baht. Answering the call for help, SWING staff have taken to the streets to raise donations and deliver food to sex workers in their network. 

Widespread coverage in the media and on personal blogs has catalysed a public conversation about the lack of social protections for sex workers. Ms Janyam also points to donations from local businesses and visits from younger people wanting to help as promising signs of how wider audiences are becoming more engaged on the topic of supporting sex workers in their communities.

The COVID-19 outbreak has also contributed to new challenges for HIV prevention. Fears of COVID-19 have deterred people from visiting clinics to be tested for HIV. Additionally, the rapid assessment findings revealed that almost half of the sex workers surveyed had difficulty accessing sexually transmitted infection screenings. In response to those observations, SWING partnered with a hospital capable of conducting COVID-19 testing, thereby drawing in sex workers interested in being tested for COVID-19 and creating an opportunity to counsel them about HIV tests. These changes in practice show possible synergies in prevention measures for both COVID-19 and HIV prevention and treatment.

“The results from the rapid assessment have proven to be a strong tool for advocacy and decision-making. Stakeholders of the AIDS response have collectively identified and started to implement priority actions as an immediate response to the needs of sex workers during the COVID-19 pandemic,” said Patchara Benjarattanaporn, UNAIDS Country Director for Thailand.

Ms Janyam reflects on what this will mean for SWING’s work and recalls the ways in which sex workers were not afforded the same social safeguards as others—they were forgotten. “We must transform ourselves. Community-led organizations must apply a holistic and comprehensive approach, providing immediate basic needs, integrating a package of prevention for both COVID-19 and HIV health services, as well as mental health support for sex workers,” she said.

She affirms that SWING and other charitable groups will continue to seek donations and provide basic provisions for sex workers, recognizing that the need for assistance will remain long after the situation eases, long after the bars and restaurants have reopened.

Pia Wurtzbach, Miss Universe 2015 and UNAIDS Goodwill Ambassador for Asia and the Pacific, has long been an advocate for the AIDS response in the Philippines and the rest of the region. Recently, however, her work has taken in support for the COVID-19 response, including starting a fundraising effort with the aim of distributing 25 000 face masks to hospitals in Manila and supporting social media campaigns on preventing both COVID-19 and HIV.

UNAIDS spoke to Ms Wurtzbach about her work during this challenging time.

How did you organize the drive to donate face masks to health facilities in Manila?

To begin with, I ordered 5000 masks with my own money to identify an affordable and reputable supplier. I found one and ordered the masks and then delivered them to four hospitals. Once I was ready and confident, I started the fundraising drive, reaching out to the private sector in the Philippines and my network of contacts. So far, I have been able to donate masks to 30 hospitals in Metro Manila. We wanted to deliver masks to other hospitals outside the capital city, but because of the lockdown this hasn’t been possible yet. In addition, I have been able to donate meals to an intensive care unit in one of the hospitals in Metro Manila. Nurses and doctors working in the unit have been living in the hospital and do not go home. With the donations, I feel I am supporting them.

How do you continue to support the response to HIV in your role as a UNAIDS Goodwill Ambassador?

Every day I am in contact with LoveYourself, the civil society organization I volunteer for in the Philippines, to update each other on what is going on and to monitor the needs of people living with HIV. I post information on my social media platforms about HIV and COVID-19 prevention and how to stay healthy. I keep my followers informed of the services provided by LoveYourself to support people living with HIV during the COVID-19 pandemic, such as home delivery of antiretroviral medicines.

What questions do you receive from people living with HIV or from key populations in relation to HIV and COVID-19?

The most popular questions are how to access medicines and whether there are going to be enough refills. It is great that organizations like LoveYourself in the Philippines help people living with HIV to access their medicines. I am really impressed with Vinn (Ronivin Garcia Pagtakhan), the founder of LoveYourself, because he has been using his own car driving around everywhere delivering medicines to people’s homes. He is like a modern-day superhero.

How have you kept motivated to continue your work in these trying times?

I am so blessed because I have a lot of friends in the industry who are nurses too. You will be surprised that my makeup artist is a registered nurse, and there are photographers who are registered nurses. In the Philippines, there are so many nurses that somehow end up doing other careers, but they are all still in the medical field and they know people in the medical field. I hear so many stories from them, and I know these are real stories about what the hospitals are like and about their environment.

Hearing their stories made me feel like I needed to do something. I feel very fortunate that I am able to stay at home. So, I thought to myself, what can I do to make myself useful? This is why I started my donation drive. The medical staff sent me messages of appreciation and even a video of them saying thank you. When I see that the people on the frontline take the time to say thank you, I want to help even more.

The fundraising campaign gave me a sense of mission and purpose. That is what I tell people. If you are at home and you have followers on Instagram, or maybe you are an influencer or a celebrity, or maybe you are just popular in school, use it! Now is the time! We cannot just sit and wait for this to be over. The solution has to come from us.

What do you miss most from your life before the COVID-19 pandemic?

I feel like I took the little things for granted. I took for granted the little commute going to work, I took for granted the travelling, I took for granted how busy I was with my work. I remember before the lockdown I got burnout because I was doing so much work. I was not getting any free days or any weekends—I was working from Monday to Sunday. And I said to myself that I needed some time alone. And then suddenly this all happened. I am just taking the time now to reflect and think about what is really important to me.

I miss everything. I miss being able to walk outside, I miss the traffic, I miss seeing other people. I feel that the lockdown is really giving us time to think about what is important for us. I feel like when we get out of the quarantine and self-isolation, we will know what to prioritize.

How do you spend your leisure now being at home in quarantine?

You know, the good thing about the lockdown is that I have more time for myself. Every day I go to the roof deck of my building to work out, so I bring my yoga mat up there and spend a few hours trying to get some sunlight and exercise. I have a routine every day, and I feel like if you have a little routine, you will feel like your days have direction. When I wake up in the morning, I try to get emails done and some work done. In the afternoon, I will work out. And at night I can bake, or watch television, watch Netflix. So, it is work, sunlight and then “me time”. I feel like this is a nice balance, because it is making yourself productive and taking care of yourself.

What are your next steps after you reach the target of donating 25 000 masks?

It is not set in stone, but my team and I are thinking of ways to help people who need economic support and donate them food. In addition, I would like to focus on social media messages on mental health to give people tips on how to control or manage their anxiety. People are at home and on their phones, so maybe they can read something that will help them manage their stress.

From the very beginning, communities were in the vanguard of the AIDS response in Nepal. Still playing a vital role in the response to HIV in the country, communities are making good-quality services more accessible for people living with HIV and key populations and standing up to HIV-related stigma and discrimination.

“Nepal made antiretroviral medicines accessible to all people living with HIV as a result of advocacy efforts led by communities, human rights activists and other national stakeholders,” said Gopal Shrestha, a prominent community leader living with HIV.

Discrimination towards key populations is still deeply rooted in Nepalese society. “Finding people who need services is difficult due to a lack of trust. We work with those communities that fear coming out because of discrimination,” said Simran Sherchan, Operation Head of the Federation of Sexual and Gender Minorities in Nepal (FSGMN).

Although antiretroviral medicines are available to everyone living with HIV in Nepal, a survey conducted in 2018 reveals that more than 30% of transgender people avoid seeking health care because of fear of stigma and discrimination—something that FSGMN is determined to end.

“Community-based organizations play an intricate role in reaching out to those hard to reach,” said Anjay Kumar KC, a community leader who advocates for harm-reduction in Nepal. Recovering Nepal, a community network of people who use drugs, is supporting harm reduction programmes and HIV prevention among young people who use drugs, including a peer-to-peer programme that provides sterile needles and syringes and a campaign that promotes HIV testing. It has also played a key role in advocating with the government to initiate opioid substitution therapy, which is now offered at 12 sites in five provinces in the country.

Community-based organizations mobilize communities to demand services and advocate for their right to health. Recently, the National Association of People Living with HIV/AIDS (NAP+N) successfully advocated to include people living with HIV in the country’s Health Insurance Programme in 57 districts across the country. “NAP+N also entered into an agreement with Prime Life Insurance Limited to guarantee people living with HIV can access life insurance services,” said Rajesh Didiya, President of NAP+N.

Despite these achievements, community-based organizations face challenges. “When I reach out to sex workers, I have to hide my identity, because sex work is still stigmatized by my family and society. That is why it is difficult to publicly raise awareness about sex workers’ rights,” said Bijaya Dhakal, Coordinator of the Nepal Federation of Female Sex Workers.

Parina Limbu, a community leader who advocates for engagement in decision-making by women who use drugs, said, “Being labelled as women who use drugs, women living with HIV and hepatitis and sex workers, we are not within the reach of programmes. Our needs should not be looked at through the lens of males who use drugs. Women who use drugs need more decision-making spaces to make sure that our voices are heard.”

Those challenges can be overcome through partnerships and joint efforts, however. The Right to Health Women’s Group, Right Here Right Now and FSGMN have created a platform to collect and monitor cases of human rights violations against people living with HIV, key populations and young people. They use the evidence that they collect to advocate for programmes on stigma and discrimination reduction in health facilities and raise awareness about the human rights of key populations with law enforcement officers.

UNAIDS in Nepal has played a key role in empowering communities. “The important role that the community plays in the country’s response to HIV should not be underestimated. The gains made are because communities are taking the initiative and acting in ways that ensure that people who need treatment, prevention and related HIV services can access them,” said Masauso Nzima, UNAIDS Country Director for Nepal and Bhutan.

Relief work is not the Humsafar Trust’s specialty, but COVID-19 has changed that.

A few days after the lockdown measures in India went into effect, the Humsafar Trust’s teams received desperate calls from people with no place to live and no income, explained Vivek Anand, Chief Executive Officer of the Humsafar Trust, a lesbian, gay, bisexual, transgender and intersex (LGBTI) people community-based nongovernmental organization based in Mumbai, India. An urgent team meeting was called to determine what to do. “After much back and forth evaluating needs, we agreed, “Let’s start with giving people food support,”” he said.

They pooled money together among themselves and bought food and other essentials.

They then reached out to their communities, telling them that the Humsafar Trust had started an emergency COVID-19 fund. In three days, more than 700 people had asked for support. “With donations from communities, allies, businesses and some donor agencies, we have helped more than 2000 individuals with food, access to medical care, like HIV medicine, financial aid and applying for government support,” Mr Anand said, beaming as his air conditioner sent waves of cold air blowing through his small home office.

He feels that during the pandemic response the LGBTI community is being overlooked. “Seventy per cent of our community comes from lower socioeconomic backgrounds with no savings,” he said.

The bulk of the Humsafar Trust’s aid is focused on transgender people, who, he said, have been the hardest hit. “Not only do they usually survive on a meagre income, a lot of them have no legal papers, making them invisible to government aid,” Mr Anand said.

The lockdown has translated into financial distress and has also resulted in mental stress. Mr Anand recounted that one member of his transgender team at the Humsafar Trust cannot introduce herself during their online outreach sessions because she is living with her parents, who consider her a boy. Others are being pressured to marry, while many have been mistreated and beaten.

Standing outdoors by a vegetable vendor to maximize cellphone connectivity, Shreya Reddy said she always wanted to be a woman. Despite being born a boy and constant ridicule and shaming, she never gave up. At the age of 13 years, she ran away and joined a hijra community, comprised mostly of transgender people. Four years later, she started transitioning gender with money she made as a sex worker. After a while, Ms Reddy said, she realized that to succeed, she needed to study. Her social work degree and background led her to the Humsafar Trust, for which she has become a peer educator and outreach worker. COVID-19 has set her back a bit for a number of reasons.

“It has been terrible, because I cannot get my hormones and I have lost weight and was bleeding,” she said. She added that because of the lockdown, no one can get regular check-ups with gynecologists. “And my community cannot understand all the rules and the science language. Basically, a lot of people like me are struggling a lot, from not being able to pay rent to buying bare necessities,” Ms Reddy said.

Speaking more and more quickly, she added, “People are not that educated, they are scared and there are lots of mistruths.”

Ms Reddy has since become better and said that she is dedicated to her outreach work. One of her transgender peers told her, “Better that I die,” once the woman’s income had melted away. "I empower myself by talking to people,” she said. “We are all so vulnerable and as a small-income population we need support.”

OutRight Action International's recent report, Vulnerability amplified: the impact of the COVID-19 pandemic on LGBTIQ people, said that the challenges faced by LGBTI people across the world as a result of the virus and containment measures were amplified compared to the broader population. Jessica Stern, Executive Director of OutRight, said, “For us the situation is dire. I fear how many LGBTI people will lose their lives because of the amplified vulnerability we face.”

Pointing to market vendors behind her, Ms Reddy said, “I have helped them too figuring out the masks and sanitizers. I help everyone, but I am scared about the future.”

Mr Anand echoed her sentiment. He has had to extend the emergency fund until August.

“Every day, there is a new challenge,” he sighed. His teams, usually out and about, can’t all work online. In addition, he mentioned that more and more people are going underground, making outreach difficult.

Recalling his youth, he explained that he was a late bloomer. “I didn’t know anyone who was gay,” he said. When his secret relationship of nine years ended, he had no one to talk to. He felt lonely and abandoned. “From then on, the Humsafar Trust became my home and my family.” He added that he would not judge anyone in these tense times, reiterating that his first duty was to help others.

What he really wants is that the transgender community be part of the narrative. “Give them a voice, let them be seen and include them in the picture,” he said.

Shahnaz Khatun (not her real name), a former sex worker now running a small clothing business in Dhaka, Bangladesh, found herself in difficulties when the country went into lockdown. Before the COVID-19 outbreak, the areas where she used to work were crowded, but now they are quiet. Ms Khatun is self-isolating in response to the government’s call, but she is unable to provide for herself and her family. “My business is now out of action due to the restrictions on movement. I have some underlying health conditions and I spent all my money on buying medicines,” she said.

As a result of the COVID-19 pandemic, sex workers in Bangladesh, like other informal sector workers, are experiencing hardship and a loss of income. With the limited support that some of them get, they can barely feed themselves and their children. Only a few of them have savings to fall back on and little access to services that could bring some relief. Conditions are more vulnerable for street-based sex workers, as most of them are homeless.

However, sex workers in Bangladesh are organizing themselves, establishing support networks to help their peers. The Bangladesh Sex Workers Network, a nongovernment organization working for the rights of sex workers, mobilized financial aid for more than 2100 sex workers across the country that was distributed through the active engagement of 26 community-based organizations. “Many sex workers have chosen this profession for the sake of their families or children, to provide them with food and a livelihood. Today, sex workers’ families are passing their days helplessly with no money in their pocket,” explains Ms Kajol, President of the Sex Workers Network of Bangladesh.

Ms Khatun received 10 000 Bangladeshi taka, equivalent to US$ 120, through the Bangladesh Sex Workers Network. “With this, I also bought food for another 30 sex workers. I am also arranging for delivery of masks, soap and food to other sex workers in my area and am teaching them about hand washing techniques, maintaining personal hygiene and social distance maintenance,” she said.

Ankhi Akhter (not her real name), who works in a brothel in Tangail, gives support for mental health issues to her peers and encourages regular communication among sex workers in order to cope with stress and to exchange thoughts. “The local governmental authority and a number of nongovernmental organizations, as well as private entities, have already helped us with food and a limited amount of money,” she said. “However, these will not be sufficient if the situation continues.”

As a result of Ms Akhter’s efforts, the Dhaka District Council Office and the Member of Parliament representing the district donated food to the brothel and distributed it among a network of 500 sex workers. The Society for Social Service, a local nongovernmental organization, offered cash payments to more than 400 sex workers and landlords postponed utility bills, such as rent, electricity and water. Most of the sex workers in the brothel received masks, soap and hand sanitizer from the brothel and volunteer organizations.

Sweety Begum (not her real name) is the leader of a community-based organization that supports street-based sex workers in Rajshahi. She relies on her husband's limited income for their living expenses and is helping other sex workers with the small amount of financial help she receives. “Street-based sex workers outside Dhaka are getting less help than those in Dhaka and they are scared to collect aid because of stigma and discrimination,” she said.

“Eleven brothels in Bangladesh have received food and some financial support from government organizations: however, this is not enough. In some areas, relief has been provided only to those who have a national identity card and, unfortunately, not all sex workers have this,” says Saima Khan, UNAIDS Country Manager for Bangladesh.

UNAIDS and the United Nations Children’s Fund have been supporting the network of sex workers to develop income-generating schemes so they can compensate for the loss of income caused by COVID-19. Also, through the network of sex workers and in collaboration with the Bangladesh Country Coordinating Mechanism, UNAIDS has supported 23 community-based organizations of sex workers to procure protective commodities such as soap and masks during the initial stages of the response to COVID-19. Advocacy with organizations to make access to aid easier for sex workers is also ongoing.

“The Sex Workers Network of Bangladesh, through collective efforts, will continue to work hand in hand, so that sex workers can fight back against any difficult situation they face together, leaving no one behind,” said Ms Kajol.

For the more than 3000 people, including 330 children and adolescents, living with HIV and on antiretroviral therapy in Goa, India, the COVID-19 outbreak is a time of worry—they are worried about COVID-19 and they are worried about being able to stay on their HIV treatment during the lockdown in India.

In order to respond to one of those worries, the team at the Human Touch Foundation, a community-based organization that provides care and support to children and adolescents living with HIV, has, since the start of the lockdown, organized a force of volunteers to deliver antiretroviral therapy to people’s doorsteps.

Health officials at the HIV clinics provide a list of people who need deliveries of antiretroviral therapy, after making sure that the beneficiaries consent. Alternatively, several beneficiaries connect with the Human Touch Foundation directly for a supply of medicine.

“Most people living with HIV are still hiding their HIV status and do not wish that we come directly to their homes for the delivery. With poor mobile connectivity, in many cases we have no option rather than make more than two trips, instead of asking their location with the villagers,” said Peter Borges, the founder and Chief Executive Officer of the Human Touch Foundation.

Along with antiretroviral therapy, the Human Touch Foundation also provides essential groceries—rice, lentils, grams, oil and milk—for children and adolescents living with HIV and their families. “Many children and adolescents are with anxiety and depression, mostly concerning their survival, due to loss of income of their families and scarcity of essential supplies,” said Mr Borges. Bars of soaps are also provided with the packages, distributed in collaboration with UNAIDS, Reckitt Benckiser, the Just Imagine Trust and the Rotary Club of Panaji Riviera.

The Human Touch Foundation is also offering online psychosocial support to children and adolescents living with HIV. “We have streamlined our communication through telecounselling and support. We have a staff team giving coordinating and rendering support to the field team through assessment of the family,” Mr Borges added.

Similar efforts are being undertaken in Bangalore to support people living with HIV. Champion in Me, a community-based organization that provides care, support and skills to adolescents and young people living with HIV, has built a support system to reach out to communities during the lockdown. A force of young volunteers has partnered with the Karnataka Network of Positive People to distribute medicines to 140 people and food provisions to 1200 people. “I praise the courage of our volunteers and supporters that came out to help people living with HIV, in a time of crisis. This is when our organizations and leaders have to stand tall and join efforts to make sure nobody is left behind,” said Elvis Joseph, the Director of Champion in Me.

At the national level, the National Coalition of People Living with HIV in India (NCPI+) is coordinating efforts with the National AIDS Control Organisation (NACO) and other partners, including UNAIDS, to ensure adherence to treatment and a continuum of care for people living with HIV.

“Since the lockdown started, the National Coalition of People Living with HIV in India established a good communication platform through WhatsApp and emails connecting the National AIDS Control Organisation and networks of people living with HIV to closely monitor challenges, find joint solutions and help coordination,” said Daxa Patel, the President of NCPI+ and the Secretary of the Gujarat State Network of People Living with HIV. As a result, NCPI+ has helped more than 45 000 people living with HIV in India to get home deliveries of antiretroviral therapy.

“HIV-affected communities have played an important role delivering antiretroviral therapy to people who were not able to collect it themselves. The Human Touch Foundation, Champion in Me and the National Coalition of People Living with HIV in India are just some examples of what can be done at the national, state or city level by communities themselves. Many local solutions have been put in place in a joint effort between the government, UNAIDS and community-based organizations to get medicines, food or soap delivered to those in need,” said Bilali Camara, the UNAIDS Country Director in India.

After the 2018 earthquake struck Lombok, in West Nusa Tenggara, Indonesia, the destruction it caused closed most health facilities. Among those affected were people living with HIV, who could no longer access their HIV treatment. Then, Yayasan InSET, a civil society organization in the province, stepped in, teaming up with health facilities in the area and taking on the role of delivering antiretroviral therapy to people in need. Today, the COVID-19 pandemic is threatening to do what the earthquake did to access to HIV treatment, and Yayasan InSET is ready to step in again.

Many people living with HIV in West Nusa Tenggara and in the rest of the country are acutely concerned about the possibility of disruption to HIV services and not being able to access antiretroviral therapy, owing to overburdened health facilities or the possibility of lockdowns. A recent rapid survey of 1000 people living with HIV conducted by the Positive Indonesia Network found that more than 41% were extremely anxious about COVID-19, with more than 36% worrying about their ability to obtain their HIV treatment.

“In West Nusa Tenggara, there are more than 500 people living with HIV on treatment who are worried about being unable to go to a clinic to access antiretroviral therapy,” said Himawan Afrian, the head of Yayasan InSET.

Yayasan InSET’s experience of working with hospitals and health centres after the earthquake has left it ready to help out in the COVID-19 outbreak. “Some health facilities actually contacted us a couple of weeks ago to ask for our help. The concern did not just come from the community, but also the health workers. Initially they asked us to raise awareness about COVID-19 prevention to our communities. Now we are working out the arrangements for us to take over the delivery of antiretroviral therapy should the situation worsen,” said Mr Afrian.

Having a close collaboration with the health services has been a big help for Yayasan InSET ensuring that people living with HIV are not left behind during the COVID-19 pandemic. Its direct advocacy has ensured that people living with HIV in the province receive a two-month supply of antiretroviral therapy. The organization has also successfully lobbied the authorities to move the HIV clinic away from the hospital, so people can swiftly pick up their medicines without entering the overcrowded clinics in the hospital, and has successfully advocated to the authorities in Mataram for the provision of food packages for sex workers and people living with HIV for six months.

During emergencies, whether pandemics or earthquakes, collaboration and local solutions are key to ensuring that there is as little disruption as possible to services for people living with HIV.