Benin

Girls’ education as a tool to prevent HIV infection has been centered at the 1st African Union Pan-African Conference on Girls’ and Women’s Education in Africa. This followed African leaders designating education as the 2024 African Union theme of the year.

At a high-level side event hosted by the Education Plus Initiative on the first day of conference held at the African Union Commission in Addis Ababa, Ethiopia, leaders, girls’ and women’s networks and advocates called for greater investments in girls’ education.

“Some people claim that providing girls with secondary education is too expensive. Such claims fail to consider the exponentially higher cost of not educating them,” said UNAIDS Executive Director, Winnie Byanyima. “We can get all our girls and boys to complete secondary education; that should be our legacy."

UNICEF calculates that 34 million girls in sub-Saharan Africa are out of secondary school. According to the Global Education Monitoring (GEM) Report 2023, in all regions in Africa, there are more girls out of school at the secondary level than boys, with gender disparities worsening as children move up to higher levels of education in favour of boys over girls. In sub-Saharan Africa, less than half of adolescent girls complete secondary education, their percentage standing at 42% and there has been no progress at all in closing this gap in the past 20 years.  Sub-Saharan Africa is the region furthest from parity at the expense of girls, with no progress since 2011 at the lower secondary level and since 2014 in upper secondary.

Gender is a key factor linked to disparities in enrolment, retention, completion, and learning outcomes through social conditioning, gender-based differences in parental expectations and education-related investments, child marriages and early childbearing, female genital mutilation, child labour, gender-based violence, period poverty and discrimination.

More than forty years into the HIV response, Africa remains an epicenter of the AIDS epidemic with adolescent girls and young women being disproportionately affected. Every week 3100 adolescent girls and young women acquired HIV in sub-Saharan Africa. Every three minutes, an adolescent girl or young woman aged 15-24 years acquired HIV in 2022 in sub-Saharan Africa.  Adolescent girls and young women aged 15-24 years in the region were more than three times as likely to acquire HIV than their male peers in 2022.

UN agencies, African Union representatives, government ministers, and young women leaders called for accelerated actions to translate commitments to action through leveraging girls' education for gender equality and preventing HIV, child marriage, teenage pregnancies, violence, gender-related stigma and discrimination in Africa.

Speakers emphasized the connection between health and education. Ministers spoke about key policy reforms and best practices aimed at promoting girls' education, including creating safe and inclusive school environments, strategies to get girls into secondary school, and the readmission policy that addresses high dropout rates due to pregnancy.  UN co-leads emphasised the need for improved collection of data disaggregated by sex and other relevant population characteristics to better understand educational participation, progression, and learning, and using gender-sensitive data for policymaking and planning. 

Other issues highlighted included the integration of digital literacy programs into the secondary education and vocational training curriculum to facilitate smooth transitions from school to employment; integrate gender equality into all aspects of the education system, including curriculum-based comprehensive sexuality education  and life skills, address gender-based violence  within schools and discriminatory laws and practices, and access to information, non-discriminatory HIV and sexual and reproductive health services access.

Young women leaders spoke on the role of partnerships and young women's leadership. Participants highlighted the upcoming 30th anniversary of the Beijing Declaration as an opportunity moment to accelerate accountability and commitments, as well as the CSW Resolution 60/2, Women, the Girl Child and HIV and AIDS as significant mechanisms to address political and resource gaps so no woman or girl is behind in the HIV response.

Education Plus is a rights-based, gender-responsive action agenda to ensure adolescent girls and young women have equal access to quality secondary education, alongside key education and health services and support for their economic autonomy and empowerment.  Co-led by five UN agencies, the initiative builds on existing frameworks like the Transforming Education Summit, the Continental Education Strategy for Africa (CESA) and the Dakar Education for All (EFA) Declaration to push for access and completion of education for women and girls in Africa.

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

Only 1.8 million people of the 6.5 million people living with HIV in western and central Africa were on antiretroviral therapy at the end of 2015. This 28% treatment coverage of people living with HIV in the region contrasts with the 54% coverage in eastern and southern Africa in the same year.

In response to this HIV treatment shortfall in western and central Africa, UNAIDS, the World Health Organization (WHO) and other partners in the region have developed country emergency catch-up plans to accelerate the AIDS response. These plans call for tripling HIV treatment coverage within the next three years.

At a meeting on the sidelines of the 70th World Health Assembly to support the catch-up plan, health ministers and other representatives of countries in the region vowed to strengthen government leadership, make structural changes in their health systems and strengthen accountability.

The meeting, which was organized by the WHO Regional Office for Africa and UNAIDS, was attended by the health ministers of Benin, Burkina Faso, the Central Africa Republic, Chad, Côte d’Ivoire, Gabon, Liberia and Nigeria and representatives of Cameroon, Guinea and Sierra Leone. They all collectively agreed to put in place strong measures to accelerate HIV treatment in their countries.

All the participants agreed that health-service delivery models had to be transformed, notably by community health workers taking a bigger role in health-care delivery. WHO and UNAIDS will continue to work with the countries as they implement their plans for increasing access to HIV treatment.

UNAIDS is working with countries to achieve the commitment in the 2016 United Nations Political Declaration on Ending AIDS of ensuring that 30 million people living with HIV have access to treatment through meeting the 90–90–90 targets by 2020.

The First Lady of Benin has launched a foundation to improve the lives of the most vulnerable women and children in the western African country, nestled between Nigeria and Togo. The foundation will work under the umbrella of six core values: solidarity, the family, respect for differences, integrity, humility and efficiency.

The Claudine Talon Foundation will take a holistic approach to improving health and social outcomes for women and children in Benin. It will focus on expanding maternal and paediatric health services, improving general hygiene and sanitation, increasing access to quality drinking water, improving standards of nutrition and raising literacy rates through a wider access to education. Activities will include increasing access to HIV testing in paediatric health centres and supporting organizations caring for orphans. It will also focus on ending discrimination for people living with and affected by HIV.

Benin has made significant progress in its AIDS response in recent years, particularly in reducing mother-to-child transmission of HIV and increasing access to life-saving antiretroviral medicines. Around half of all adults living with HIV in Benin currently have access to treatment. However, key populations are still disproportionately affected by HIV. The foundation hopes to break down the stigma preventing people from accessing life-saving HIV services.

The importance of scaling up support services for women and young people in Benin is evident. Estimates show that 39% of people live below the poverty line in the country and that 45% of the population is under the age of 15.

The Executive Director of UNAIDS, Michel Sidibé, was present at the launch and said that the humility and profound commitment of the First Lady to creating a fairer and more just society will improve the lives of women and children in Benin, restoring dignity, inspiring change and creating opportunity. The First Lady thanked Mr Sidibé and UNAIDS for the support given to the foundation and to the response to HIV in Benin.

The first thing you notice about Colonel Alain Azondékon is that he is always moving. He is tall, head and shoulders above most people, and he uses his whole body to express his feelings. So it will come as no surprise to learn that he ends every sentence with, “Let’s go!”.

The Director of Camp Guezo, the paediatric HIV hospital in Cotonou, Benin, the Colonel has started a new movement for putting young people and families at the centre of care.

After observing traditional check-up visits, he noticed that the children were separated from their mothers by a curtain during the examination. He rearranged the furniture, making sure that the examination table was parallel to where the parents were sitting, so they could always be in eye contact with their little ones and with the doctors and nurses.

That was just the beginning. He noticed that the young people under his care needed more than medicines to lead healthy lives. He introduced psychosocial support to address the stress of living with HIV through adolescence and created a network of young people living with HIV, run by a young man who is also living with HIV.

Talking with the Colonel you get the sense that he has tried to think of everything. “A mother never comes alone,” he pointed out. “She has her children, sometimes the father comes and she has her handbag, which contains her “life”.”

The Colonel made sure that instead of chairs in the examination and therapy session rooms there were small sofas—enough places for the family as well as the mother and her handbag.

It’s the small details, as well as the big mandate, that have made Camp Guezo so successful. Children born with HIV have received care from birth. The paediatric hospital has been able to reduce mortality rates among children living with HIV from 30% to less than 5%.

Some of the patients are now adults with children of their own and have very little interest in moving to the regular health-care system.

“They sometimes call me Papa, and they ask why Papa do we have to go to the other clinic where they don’t know me,” he said.

Soon patients of Camp Guezo could find it easier to transition to other health-care facilities. The Colonel has been asked to help replicate this model in other clinics in Benin.   

“This is the kind of people-centred approach Africa and the world is looking for,” said Michel Sidibé, the Executive Director of UNAIDS, as he toured the centre. “Precious resources have been carefully put to work to keep families in a safe environment where they can get the care and support they need.” 

There are an estimated 69 000 people living with HIV in Benin. The number of new HIV infections among children continues to fall as pregnant women living with HIV gain access to life-saving antiretroviral medicines to stop babies from becoming infected during childbirth and breastfeeding.

On the sidelines of the 71st session of the United Nations General Assembly, UNAIDS Executive Director Michel Sidibé has met with the President of Benin, Patrice Talon.

Mr Sidibé praised the country for integrating HIV and health services to include tuberculosis and other epidemics, as well as Benin’s efforts to stop HIV transmission from mother to child.

President Talon said that we have the tools to end all forms of HIV transmission.

The wide-ranging conversation covered a number of issues focused on innovation and integration, including the untapped potential for local production.

President Talon and Mr Sidibé were joined by First Lady Claudine Talon, who has made health one of the issues she is championing in Benin. 

Benin recently made news as one of nine countries in Africa to make contributions to the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

L to R: Dr Sonia Boni, Executice Secretary, National AIDS Committee; Professor Kindé Gazard, Minister of Health; H.E. President Boni Yayi, President of the Republic of Benin; Dr Mamadou Diallo, UNAIDS Director, Regional Support Team for West and Central Africa; Ms Nardos Bekele-Thomas, United Nations Resident Coordinator.

At an extraordinary session of Benin’s National AIDS Committee on 23 October, President Boni Yayi called for a series of measures to accelerate progress in the country’s AIDS response. Held at the Palais des Congrès in Cotonou, the session was attended by more than 350 participants, including ministers, ambassadors and representatives from the private sector, civil society, networks of people living with HIV, and United Nations agencies.

According to government estimates, about 60 000 adults and children are living with HIV in Benin. Over the past decade, Benin has succeeded in reducing national HIV prevalence—from 4.1% in 2001 to 1.2% in 2012. Eight out of ten people living with HIV now have access to antiretroviral treatment and one in two HIV-positive pregnant women have access to services that prevent new HIV infections in children.

To build on these gains, Benin’s President called for improved governance in the AIDS response. He announced that he would rapidly undertake a national audit of the country’s AIDS structures—including the National AIDS Committee (NAC), the Global Fund Country Coordinating Mechanism (CCM) and the national AIDS Control Programme (NACP)—and said that the NAC’s Executive Secretariat, previously under the authority of the Minister of Health, would be placed under his direct leadership.

President Yayi pledged to address the recurrent issue of HIV drug stock-outs by simplifying procurement procedures and adopting special custom regulations for antiretroviral medicines. He said he would focus national efforts on achieving the twin goals of universal coverage to HIV treatment and the elimination of mother-to-child transmission of HIV by 2015.

Though Benin has increased its AIDS budget in recent years, more than 75% of national AIDS investments are funded through external sources. In the spirit of shared responsibility, President Yayi pledged to increase the national HIV budget from US$ 1.2 million to US$ 3.2 million. A new airfare tax earmarked for the national AIDS response was also highlighted.

Donors attending the meeting congratulated Benin’s Head of State on these measures. “This is a true example of shared responsibility in action, which is advocated by the UNAIDS Executive Director,” said the Ambassador of France, Jean-Paul Monchau.

The meeting in Cotonou offered a platform for dialogue between all AIDS stakeholders around the implementation of the African Union’s Roadmap on Shared Responsibility and Global Solidarity for AIDS, Tuberculosis and Malaria.

Launched in July 2012, the Roadmap offers a set of long-term sustainable strategies to finance and provide access to HIV treatment, prevention and other health services in Africa. In his capacity as Chair of the African Union, President Yayi presented the Roadmap to African leaders at a September 2012 high level side event of the UN General Assembly.